January 27, 2011 
The Florida Pharmacy Association along with a local pharmacy in Florida have filed suit against the state for allowing Medicaid patients to use mail order. This seems silly to me. The mail order pharmacy ship has sailed a long time ago. Approximately 13% of all prescriptions filled in the US are through mail order.
While I would still disagree if it was mandatory mail, this isn’t. The state is simply giving patients the option to get their drugs through mail order. If the community pharmacies have an issue, they should match the mail order rates and dispense 90-day prescriptions and delivery them to the patient’s house at no cost.
We’re in a budget crisis here as a country. If we can save money in Medicaid and therefore in the state budgets, why wouldn’t we do it?
The lawsuit says that the change –
“at a minimum deprives the patients’ access to a provider having extensive knowledge of their medical conditions and unique clinical problems.”
Really? I’d love to know how many of those Medicaid patients have a long standing relationship with their pharmacist, know them by name, and don’t use multiple pharmacies. Maybe I’m wrong.
It comes down to losing business BUT if the patients are so happy, won’t they stay with their local pharmacy. This is a transient population so it’s always been hard for mail order. It’s not easy to send them refill reminders. There’s not always a consistent address to mail to. Some of that is changing as text messaging becomes more normal as a communication medium, but that’s still a small percentage of companies.
Enabling Healthy Decisions 
Dear Independent Community Pharmacy Leaders
I am deeply concerned as independent community pharmacist. FDA Advisory Committee recommended to approve last week new potential blockbuster weight loss drug Qnexa developed by pharmaceutical company Vivus. It’s PDUFA date is April 17 2011. We as independent pharmacy community must act fast.
In its REMS (Risk Evaluation and Mitigation Strategies) proposed by Vivus, Qnexa can be only dispensed by mail order pharmacy. This is outrageous. Qnexa is combination of Topiramate and Phentermine. Topiramate portion of Qnexa is know to cause oral cleft in fetus when mother exposed to topiramate in first trimester of pregnancy. Qnexa also has unknown cardiovascular risk. Vivus’s approach is to reduce public from initial exposure to Qnexa is by restricting number of pharmacies.
I’ve worked for national chain community pharmacy for many years before. Do you really believe mail order pharmacy and pharmacists can do better job in monitoring, documenting, drug utilization review, promoting positive outcome of drug usage and fight against obesity epidemic in this country than independent community pharmacist?
I work for independent community pharmacy in Bronx NY now. You can call it momma’s and papas’s pharmacy. I know my patients and community, I know what they eat and drink, which restaurant they like go to eat, I know which gym they go work out. I know them by faces and names.
FDA thinks Qnexa has major safety concern. FDA want to make sure patient of child bearing potential uses birth control. Let me ask this question if patient gets oral contraceptives at their local community pharmacy and gets Qnexa from mail order pharmacy, one month patient skips taking oral contraceptives, how would mail order pharmacist know she is not on oral contraceptives?, I dispense topiramate and phentermine daily basis how come same restriction is not on them now.
Instead of focusing on the risk only, we should focus on benefits too, instead of restricting public exposure to Qnexa by restricting pharmacies to mail order pharmacy is not going to minimize the risk. We should work towards maximizing benefit and reducing risk by having more healthcare providers involve in fight against obesity in this country.
I propose registering doctors, pharmacies, patients nationwide approach. Let the healthcare providers and patients fully aware of risks, same time monitor outcome efficiently. Make this approach nationwide and every level of healthcare industry should be aware of such measure initiated by federal government. However funding should come from pharmaceutical company who makes billions dollars from marketing anti-obesity drug.
We must write to Chairwoman of FDA asap. This REMS is deeply flawed.
Independent pharmacist can do far better job than mail order pharmacy fight against obesity epidemic in this country because we know them by name, we know our patient, We know our community.
We Independent pharmacist must speak up on this issue ASAP. Write to FDA. Vivus should propose better REMS.
While pharmacists are clearly important in the healthcare chain (you wouldn’t get your prescriptions filled without them), I agree with you that it is fair to say that no one has a long standing relationship with their pharmacist.
I may be wrong or perhaps I don’t see the right pharmacist, but, I have never had a meaningful conversation (i.e. about the drug) with a pharmacist.
Other than to drop off your prescription, pick it up, and pay for it, and perhaps chit chat about the weather, could there be a meaningful dialogue between a pharmacist and a patient in the “pick up prescription” line? Wouldn’t there be patient privacy concerns?
As was mentioned in Pharmacy Insight (http://pharmacyinsight.co.uk/) — “The use of a pharmacy consultation room would go some way to address this as they are private areas where pharmacist and patient can have a discussion and not be overheard.” But, when did the local CVS or any other pharmacy have a consultation room?
And, yet, a recent CVS study found “New Study Finds Pharmacists and Nurses are the Most Effective Health Care ‘Voices’ in Promoting Medication Adherence”. Ok, I think that nurses might play a vital role with patients they develop a therapeutic relationship with, but your local pharmacist? I think that there are too many privacy issues here (for further thoughts and link to the CVS study, please see my blog at http://boxcuttersinc.wordpress.com/).
What do you think?