Pepin’s Pharmaceutical Prattle for 05-10-2004

Quote of the day:  Be a craftsman in speech that thou mayest be strong, for the strength of one is the tongue, and speech is mightier than all fighting.   Maxims of Ptahhotep, 3400 B.C.

Good morning!

Item seven this week may require a fight but the conclusion appears inevitable. The words of Tommy Thompson that "reimportation is inevitable" gave fuel to the fire and the states pushing the envelope gained momentum once again.

What constitutes "strength of the tongue"?  How do you persuade? Find the "WIIFM"…"what's in it for me" and you are on your way to changing someone's mind. Show the people whose opinion you wish to change how doing it YOUR way will result in advantage to THEM.

It MAY be to your advantage to read the PPP each week to stay current on pharmaceutical happenings. It may be in your best interest to patronize our advertizers..... because it will keep PharmWorks profitable so we can continue to provide the PPP at no charge to you.

1) FDA say no over the counter status for "morning after pill".

The drugs remain available on prescription but will not be available over the counter.

This goes against the advice of the advisory committee. but the FDA does not always go with the majority vote of the committee. Expect more pressure to change the status of the product in order to allow even the youngest sexually active kids access to these chemicals without parental knowledge (we're taking about girls 10 to 16 people… those who are too young to vote, drink, smoke, or be out past curfew are supposed to be able to make such life and death decisions on their own).  I'm with the FDA on this one.

 http://www.fda.gov/bbs/topics/news/2004/NEW01064.html   

2) Drugs may stimulate cancer as well as red blood cells.

Expect this one to receive some major attention because of all of the emotions around cancer and because there is so much money involved. If it turns out that increased cancer risks occur with these biotech drugs then physicians will just have to take that into account. I don't see the drugs going away or used in fewer patients….. time will tell.

 http://news.moneycentral.msn.com/ticker/article.asp?Feed=RTR&Date=20040504&ID=3661069&Symbol=US:JNJ

3) Surprise…surprise… surprise…. Fat kids are bullies or bullied.

As kids take after their parents and pack on the pounds do we expect that everyone will either be bullied or the objects of physical and mental abuse? Study found that over weight girls were more physical and the overweight boys were more likely to lie and gossip. As the fat kids are more socially isolated they retreat to video games and TV…. not exactly aerobic activities…… (why can't we all just get along?) 

http://www.comcast.net/News/HEALTHWELLNESS/XML/1500_Health__medical/eba41bdb-262f-4335-8077-1e44907ad908.html 

   Need promotional items like t-shirts, mugs, and pens? 

(Talk to my friend Aaron at e-ffective media... he also has a $1000 contest going)

4) Complicated Medicare website reported last week in PPP….

This week pricing errors are reports….Medicare website is "iffy" at best.

http://story.news.yahoo.com/news?tmpl=story&cid=534&ncid=534&e=1&u=/ap/20040501/ap_on_he_me/medicare_drug_card 

5)  One way for a drug company to save some money....

New drug, known as RSR13,  canned before it got a real name. The drug companies spend millions on drug names. This one would have enhanced the effect of x-rays on tumors.

http://news.moneycentral.msn.com/ticker/article.asp?Feed=RTR&Date=20040503&ID=3657050&Symbol=US:ALTH

 6) Eszopiclone or Estorra (as in Restore) seem to help the elderly sleep. Not yet FDA approved but headed that way. Look for this to be a major direct to consumer advertising area this year (if the 2004 elections don't buy up all of the air time….sleeping pill anyone?... no thanks!)

http://news.yahoo.com/news?tmpl=story&cid=97&u=/hsn/20040506/hl_hsn/trialpillhelpselderlyinsomniacs&printer=1 

7) Reimportation raises concerns for bald headed pharmacist.

Prior to now I has assumed that rational thinking would prevail and that reimportation was dead.

 Now we have to assume that Congress will pass a reimportation law….

http://www.newsday.com/ CANADIAN IMPORT STORY

 CVS and other pharmacists are backing a new law so they can buy “Can-wholesale” from Canada. California pharmacist association has backed it for a long time for the same reasons. In each case it appears that the price to consumers would be the same and that the pharmacies would keep the difference.

 Each Canadian drug does not have an NDC but has a different, less specific number called a DIN.These DINs change more frequently than NDCs. Wouldn’t it be misbranding for those pharmacies to submit claims to a PBM using an NDC?

 If the PBMs load the DINs from FDB (they have them) will NCPDP standard accommodate the use of DINS?

During adjudication, will discounts be taken off of the AWP connected to the DIN or to the erroneous NDC? (Isn’t dispensing from a bottle of 1000 with its own NDC but charging using the NDC of the bottle of 100 fraud?).

Will the CVS pharmacies just keep the difference between their Canadian wholesale price and the American wholesale price?

Will paper claims from Canadian pharmacies adjudicate?

Will Canadian pharmacies be invited into “the network” so that direct claims can adjudicate? What will these pharmacies be considered, retail or mail? Will the big PBMs build mail order facilities in Canada?

I believe that these issues need to be part of the national debate BEFORE the legislation goes to Congress.

I think the public expectation is that the public will save the difference in costs. I believe that pharmacist feel that they should keep the difference. I’ll bet that Congress thinks that the government will save the money. And I believe that they are all wrong.

 “If you want to understand the politics then follow the money”…. I can’t keep track of the money in the proposed law and it will be the “wild west” all over again if it is not spelled out in the legislation. (I can just see the Trial Lawyers lining up outside of the OK Corral.)

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