NACDS to FDA advisory committee: Curb DXM abuse without impeding appropriate use
ALEXANDRIA, Va. As the Food and Drug Administration’s Drug Safety and Risk Management Committee debated Tuesday on ways to curb abuse of cough suppressants containing dextromethorphan, the National Association of Chain Drug Stores testified that the scheduling of dextromethorphan under the federal Controlled Substances Act is not the right solution.
“Dextromethorphan is consumers’ No.1 choice to treat cough. Depriving consumers of the option to self-medicate with dextromethorphan would have substantial public health consequences because cough and cold are extremely prevalent in the U.S. population, affecting the average adult two to four times per year,” NACDS VP regulatory affairs Kevin Nicholson said to the FDA Drug Safety and Risk Management Committee.
NACDS also urged the committee to consider the approach set forth by Sen. Dick Durbin, D-Ill., in the Dextromethorphan Abuse Reduction Act of 2009, which would prohibit the sale of dextromethorphan to minors.
“Dextromethorphan is the most common ingredient in over-the-counter cough medicines in the United States,” Nicholson stated. “[The] abuse of dextromethorphan is concentrated primarily among teenagers, and this concentration makes possible a targeted and strategic approach to preventing abuse.”
In addition to working on legislative remedies, the association also has worked with the White House Office of National Drug Control Policy and the Drug Enforcement Administration to help raise awareness of the scourge of medication abuse, particularly among young people.
HHS: States must ask for more Medicaid funds
When President Barack Obama signed an emergency federal spending bill Aug. 13, it gave cash-strapped states a chance to share $16.1 billion to extend an enhanced Medicaid spending program, not to mention $10 billion in stopgap funds for teachers in danger of being laid off. But the states still have to ask for it.
That was the message from Health and Human Services secretary Kathleen Sebelius to all 50 state governors. In an Aug. 16 letter, Sebelius told every state chief executive that the emergency spending measure “can stave off the deep cuts to Medicaid that many had feared, and sustain jobs in hospitals, health centers and communities across the country.” However, she added, “these funds are only available for your state if you request them within 45 days of enactment, or by Sept. 24, 2010.”
The spending bill extends for six months the enhanced federal medical assistance percentage. “The FMAP increase was initially authorized by the American Recovery and Reinvestment Act … and is set to expire this December,” the HHS secretary told the governors. “Under the new law, states that request these funds will receive a 3.2 percentage point increase in their FMAP from January to March 2011, and a half percentage point increase from April to June 2011. Additional FMAP increases are available for each calendar quarter during this period for states with high unemployment rates,” Sebelius added.
“I encourage you to take advantage of extended Medicaid support available to you through the Education Jobs and Medical Assistance Act,” Sebelius told the governors. “This new law, along with the Affordable Care Act, will help support jobs and build a healthcare system with lower costs, more choices and higher-quality health care for all Americans.”
Telemedicine: A remote connection
NEW YORK —The doctor and the pharmacist will see you now. Just look into the webcam on the computer.
Spurred by a perfect storm of conditions—a fractured economy that has made some pharmacy labor costs prohibitive, an explosion in new digital communications technologies and a flood of new federal cash to spur the adoption of health information technology—pharmacies, physicians and managed care organizations increasingly are turning to telemedicine to bring real-time care to hard-to-reach patients in remote locations throughout the United States.
Linking distant, far-flung patients in real time with pharmacists by a secure dispensing and two-way video-communications kiosk at a clinic, retail site or even a dedicated room in a city hall—which is the case in at least one small town that lost its sole pharmacy—can mean accessible pharmacy care for millions of patients in rural and small-town settings. The potential benefits of telemedicine go way beyond pharmacy dispensing and video-link counseling, of course. Properly applied, telemedicine—more broadly defined by some as telehealth—can put patients in immediate touch with a whole battery of healthcare professionals for any number of interventions. Those interventions can range from smart phones that monitor a diabetic patient’s glucose levels to a trauma team walking a medic through a triage procedure for a wounded soldier on a battlefield in Afghanistan—and can come through mobile phones, webcams or any other device that opens an instant link between patient and practitioner.
One big impetus for the growth of telemedicine will be the federal government. As part of the Obama administration’s $787 billion economic stimulus plan contained in the American Recovery and Reinvestment Act, more than $19 billion has been allocated to support the health system’s conversion to electronic record-keeping and health IT—including telemedicine.
Telepharmacy solutions are coming from a slew of technology providers, sometimes in partnership with retail pharmacy chains. For Maple Grove, Minn.-based Thrifty White Drug Stores, its commitment to remote-site dispensing beginning in 2003 was driven by necessity; the high costs of operating a fully staffed pharmacy in some distant, smaller communities were prohibitive.
Thrifty White’s answer: Operate a smaller store with a prescription kiosk, staffed by a technician and monitored by a company pharmacist at a full-service pharmacy dozens of miles away. “Our goal is to provide pharmacy services to these under-served areas and keep the business local” said Gary Boehler, EVP pharmacy operations for Thrifty White.
More recently, another Minnesota pharmacy operator, Sterling Drug, turned to pharmacy automation specialist ScriptPro to install its Telepharmacy unit in the town of Adrian, Minn., after that town lost its one drug store. The unit, staffed by a pharmacy technician, serves the prescription needs of the town’s roughly 1,200 residents from a Sterling Drug location in a larger, nearby town, Worthington, Minn.
“Mail order should not be the answer to these communities,” said Tim Gallager, VP pharmacy operations for Sterling’s parent company, Astrup Drug. “You can expand pharmacy services for less than the cost of opening a new pharmacy and support remote pharmacies without adding staff or recruiting pharmacists.”
Major chains also are weighing in. Rite Aid unveiled a new online chat capability in early August that gives customers enrolled in its wellness+ rewards program direct, 24-hour access to a Rite Aid pharmacist. Wellness+ members can access the feature, called “Ask a Pharmacist—Chat Live Now,” via a link on their online personal health page.
Walgreens also rolled out a new, real-time link between patients and pharmacists early last month called Walgreens Pharmacy Chat. The service puts customers in touch with a pharmacy staff member via an online link, 24/7.