Many patients go without their prescribed medicine due to the slow or ineffective service of mail order pharmacies, according to a survey of just over 400 patients conducted by the National Community Pharmacists Association (NCPA). The findings both raise troubling questions about the impact mail-order programs have on patients and contradict two purported benefits of mail order: increased convenience and lower costs.

The survey found 48% of respondents who were mail-order customers had to go without their medications because of late delivery. Those patients who were required by their health plan to use mail order reported much higher rates of late delivery (63%) than those who had a choice of pharmacy (28%).

Patients also reported routinely paying for prescription drugs twice: once for the mail order and a second time at community pharmacies for an emergency fill when the first purchase did not arrive in time. Nearly every patient (85%) left waiting for their medicine by mail reported having this experience. In addition, patients expressed frustration with being forced to purchase a 90-day supply via mail order only to have the doctor write a new or different prescription two weeks later - leaving the patient with two months worth of unusable medicine.

“These survey results should make employers and other health plan sponsors think twice before imposing a mandatory mail order requirement on their patients,” said Bruce T. Roberts, RPh, NCPA executive vice president and CEO. “Mail order programs claim to provide patients greater convenience and lower cost. In fact, patients say they have to wait too long for their drugs and some are paying twice for them.

“Further, mail order is touted as a way to ensure patients stick with their medication therapy. But if deliveries arrive too late or are compromised, patient adherence is severely undermined, not encouraged,” Roberts added. “Clearly, Congress should protect the patient’s ability to choose where to fill prescriptions in any publicly financed health plan.”

As a result of their experiences, 81% of respondents told NCPA they strongly or somewhat oppose a mandatory mail order requirement being imposed on health plan participants.

Mail order pharmacies are owned by the giant pharmacy benefit managers (PBMs), like CVS Caremark, Medco Health Solutions, Inc., and Express Scripts, Inc., hired by health plans to administer drug benefits and negotiate prices. With the authority to set prices for themselves and their retail pharmacy competitors, PBMs routinely stack the deck in favor of their mail order providers and against community pharmacies. It’s common for PBMs to charge a plan sponsor a much higher amount than it would a community pharmacy for dispensing the same prescription - pocketing the difference and passing those higher costs on to health plan sponsors and, ultimately, patients without disclosing them.

To ensure these problems aren’t exacerbated by the Congressional health care reform legislative efforts, NCPA is urging that any “public option” health insurance plan be administered by a more transparent and accountable model, such as the pharmacy benefit administrator (PBA) under Medicaid.

To conduct the poll, NCPA officials sent an eight-question survey to pharmacies to display on store counters for patients to complete on a voluntary basis. The survey included an option for respondents to submit brief comments about their experiences. Below are a few examples indicating the survey struck a chord with patients:

Patient #1: “I feel I should have a choice as to where to pick up my meds. Also my meds change quite frequently and mail order doesn’t take that into account.”

Patient #2: “Multiple times during the year we have not gotten our medications on time. We should not worry when we are going to get our life saving medications.”

Patient #3: “The medications that would be mailed must be kept cool. I’m not home often and it would be a major inconvenience to return home just to get medications from outside into the fridge.”

Patient #4: “Medicine always seems to be changed from what my doctor wrote.”

Patient #5: “My brother gets his meds through the mail and they just leave them outside-Do not knock or ring the doorbell-and two times they said they delivered them-We did not get them.”

Patient #6: “I recently received another patient’s prescriptions, which I do not take. Still haven’t been picked up, but the co-pay was charged to me.”

Patient #7: “My insulin has come with chunks of frozen ice floating in the vial - plus in a plastic bag with no support - it is a wonder they did not break. I had to pay for medicine out of pocket … These are just a few of the things they have done. Mail order should not be mandatory, we should have a choice.”

Patient #8: “I have had these medicines delivered and they went to the wrong address and then were opened. Not only would I not take it then due to being opened, my neighbor saw what meds I was taking!”

Source
National Community Pharmacists Association

The maker of Children’s Tylenol has recalled several varieties of the product after discovering possible contamination with a Gram-negative bacteria, Burkholderia cepacia.

McNeil Consumer Healthcare informed physicians and other providers of the recall in a Sept. 18 letter. The company said no bacteria have been found in finished products, but the bacteria were detected in an examination of the bulk materials used to make the medicine.

The company cautioned that infection with the bacteria can be serious in high-risk persons, including those with pulmonary disease, cystic fibrosis, or immune systems that are otherwise compromised.

The recall covers 21 flavors of its pediatric acetaminophen product, including Children’s Tylenol Suspension 4 oz. strawberry, Children’s Tylenol Pediatric Suspension 1 oz. cherry, and Infants’ Tylenol Suspension Drops ½ oz. grape, manufactured from April 2008 through June 2008.

The recall does not apply to Children’s Tylenol Meltaways and Junior Strength Tylenol Meltaways.

A complete list of affected lots is available from the manufacturer.

• Explain that a variety of FDA-approved tests for flu infection that give fast results are available at physician offices and clinics, but note that these were developed and tested against previous seasonal flu strains, not the pandemic H1N1 flu.
• Explain that this study involved two small outbreaks in a single city. The findings may not be generalizable to outbreaks in other locations.

Rapid influenza A/B tests did not work particularly well when used to flag novel H1N1 cases in two Connecticut schools, researchers found.

Sensitivity of the rapid tests was just 47% in testing 63 schoolchildren with flu symptoms, of whom 49 were later confirmed to have novel H1N1 infections, reported J.R. Sabetta, MD, of Greenwich (Conn.) Hospital, and colleagues.

Writing in the Sept. 25 issue of the CDC’s Morbidity and Mortality Weekly Report, the researchers said the findings “affirm recent CDC recommendations against using negative [rapid test] results for management of patients with possible 2009 pandemic influenza A (H1N1) infection.”

The cases arose early in the current outbreak of H1N1 flu, in late April and early May. At both schools, children came down with flu symptoms after overnight field trips; 63 eventually underwent diagnostic testing at Greenwich Hospital.

Physicians at the hospital completed a standard symptom survey for each child and took nasopharyngeal swabs.

Samples were sent to the state public health lab for gold-standard molecular analysis, while rapid testing for viral antigens with the Remel Xpect influenza A/B kit took place at the hospital.

No antiviral drugs were given prior to sample collection.

In the 49 children found to have H1N1 flu by polymerase chain reaction (PCR) testing, 53% had negative results on the rapid test.

Specificity of the rapid test was better at 86% — two false positives among 14 children with negative PCR results.

Sabetta and colleagues found no correlations between the false negatives and such factors as severity of symptoms or the lag between onset and testing, although the number of patients was relatively small.

The researchers also found no notable difference in rapid test sensitivity for children who met CDC criteria for influenza-like illness versus those who didn’t. The criteria include fever of at least 100° F plus cough and/or sore throat in the absence of another known causative factor.

The accompanying editorial note said the Connecticut experience was in line with earlier findings of poor sensitivity for current rapid flu tests, even for non-H1N1 seasonal strains.

For example, the QuickVue Influenza A+B test marketed by Quidel had shown a sensitivity of 27% for 2008 seasonal flu viruses.

The performance of the Remel product in seasonal flu testing was a great deal better: 92.5% sensitivity and 100% specificity, the editors said.

But other reports have found that the novel H1N1 virus frequently escapes detection with tests originally developed around seasonal flu strains.

Sensitivities as low as 18% have been reported for some products, although others have shown rates up to 67%.

“The results of these studies and the findings in this report affirm that a negative result for this rapid test does not rule out 2009 pandemic influenza A (H1N1) virus infection in an individual with symptoms consistent with influenza,” according to the editorial note.

Factors that might depress the sensitivity of rapid tests include improper specimen collection and handling and long intervals between symptom onset and sample collection, the editors noted. But Sabetta and colleagues said their data argued against the latter, and asserted that they had followed the label instructions in collecting and processing samples.

The MMWR editors noted that the report covered two small outbreaks in a single location. Under other circumstances, they suggested, the rapid test’s performance might have differed.

They emphasized that rapid flu tests can still be useful “during the normal influenza season.”

They also called for new, large studies to evaluate rapid tests for detecting pandemic H1N1 flu and to identify ways to improve rapid H1N1 diagnosis.