Saturday, April 19, 2014
Inquirer Daily News

POSTED: Thursday, April 10, 2014, 11:30 AM
Filed Under: Michael Cohen

I wanted to remind women about an issue with the prescription product Angeliq, a hormone-based medicine used to relieve the symptoms of menopause. Unfortunately, we’re aware of errors where it’s been dispensed or prescribed improperly as an oral contraceptive.

Our sister organization, ISMP Canada has received two reports where a physician provided a woman with samples of Angeliq to take as birth control. Both women took Angeliq for several months until the samples were finished. The mistakes were discovered when the women took prescriptions for further supplies of Angeliq to their pharmacies and referred to them as “birth control pills.”

Angeliq has a number of similarities to birth control pills that might have played a role in the mix-up. The labeling and packaging is similar in design to birth control pills. It’s available as a 28-day blister pack like many birth control pills. “Angeliq” also sounds like a woman’s name—many birth control pills also have female-sounding names (e.g., PORTIA, YASMIN).

POSTED: Thursday, April 10, 2014, 10:44 AM
Filed Under: Daniel Hoffman

Last year the authorities in China exposed a pattern of systematic corruption by GlaxoSmithKline (GSK) and other pharma companies.  Labeled as "Chinagate" in the media, it involved senior pharma managers in China that routinely bribed physicians, hospital administrators and government officials to favor the selection and use of specified drugs.  As an interesting wrinkle to the scheme, the pharmas laundered their bribe payments through travel agencies to make the payoffs appear on the books as travel expenses.

Now it appears that the industry regards Chinagate as "just a blip that it has resolved" (see here) to the point where it is "nothing more than a temporary setback."  For this reason the pharma companies feel they can continue pouring resources into growing foreign countries such as China and India.  Asked whether the China scandals have chastened the pharmas and led them to substantially revamp their operations in the emerging countries, one CEO revealed that any reforms will likely be limited because, "We don't want to do anything that puts us at a competitive disadvantage." (See here.)  Another CEO shrugged and stated that even the strictest compliances programs won't necessarily work if savvy employees in those countries seek to evade them.

Then this week, amidst the claims that overseas bribery is a thing of the past, comes word that GSK is under investigation for corrupt practices in, of all places, Iraq.  This controversy involves "claims that the company hired government-employed physicians and pharmacists in Iraq as paid sales representatives to improperly boost use of its products."  (See here and here.)  The Wall Street Journal's report on the matter cites sources that claim GSK's actions may violate the U.S.'s Foreign Corrupt Practices Act (FCPA) and the U.K.'s Bribery Act.

POSTED: Thursday, April 3, 2014, 5:00 AM
Filed Under: Michael Cohen

Homeopathic remedies can be found on the shelf in just about every pharmacy, including the large chains like CVS, Walgreen and Rite Aid. Those who advocate their use believe that symptoms of illness are a normal response in the body to regain health. If a particular substance is causing these symptoms, homeopathic practitioners believe that giving a person a very small amount of that same substance will help boost the body’s normal healing process and cure the illness.

According to the National Center for Homeopathy, more than 500 million people worldwide use homeopathic remedies.  However, in my opinion these products offer nothing more than a placebo effect (sugar pills) at best and at worst they waste people’s money. Some of the claims made about them could impede effective therapy. I’m not even sure that patients realize they are using a homeopathic medicine because they may not be prominently marked as such.

The highly diluted active ingredients in homeopathic remedies are usually made from plant material, although some are made from specific minerals, salts, and insects. Very few are made from animal products or disease material itself. Most homeopathic remedies start with these active ingredients but have very little left after the dilution process. They are available in various forms, including capsules and tablets, creams and ointments, gels, granules, liquids, and sprays.

POSTED: Monday, March 31, 2014, 6:00 AM
Filed Under: Daniel Hoffman

Last week Merck and GlaxoSmithKline (GSK) announced they will suspend co-pay cards because, under the Affordable Care Act, these cards could constitute a possible kickback and expose the pharma companies to legal liability (see here).  Therein hangs a tale.

First, here's a bit of background on these co-pay cards.  For most prescription drug plans, insurers and other payers charge consumers co-payments that generally range from five to fifty dollars per prescription.  With many of the expensive specialty drugs, however, payers with growing frequency are charging consumers somewhere between 20% and 40% of the prescription's total cost.  Given that specialty drugs can cost upwards of $50,000 per patient per year, the co-payments can pose an enormous financial burden on most people.

Pharmas believe they can continue to charge exorbitant prices and preempt public outrage by relieving consumers of that co-payment burden with cards that patients receive from their physician and present to the pharmacy.  Instead of a patient failing to fill a prescription for a medication costing $100,000 a year because it would take between $20,000 and $40,000 out of his pocket, he can fill the scrip and the pharmaceutical company gets to pocket between $60,000 and $80,000.

POSTED: Friday, March 21, 2014, 9:52 AM
Filed Under: Michael Cohen

Three out of four people make mistakes when measuring doses of liquid medicines, particularly when using dosing cups that come with OTC medicines. More than one-third of the mistakes are large overdoses, which can be particularly serious in children.

The errors are most often due to: 

1) confusing teaspoons with tablespoons, especially since the markings “tsp” and “tbsp” look similar;

POSTED: Monday, March 17, 2014, 9:34 AM
Filed Under: Daniel Hoffman

A survey of 595 employers, each with 1,000 or more employees, by consultancy Towers-Watson (see here) showed that: (1) employers are shifting more costs to workers in the form of higher premiums and more out-of-pocket payments, (2) fewer and fewer employer plans will cover spouses/families, (3) subsidized health insurance to retired workers is ending and, (3) most employers (76%) say they won’t even cover their workers by 2024.

Even as the employment basis for health insurance in the United States is eroding, the costs for health care services, medications and devices keep rising substantially.  The sectors most responsible for these escalating prices are providers (e.g., physicians, hospitals, diagnostic and therapeutic centers) and manufacturers.

Take pharmaceutical manufacturers as an example. In April 2012 the pharmacy benefits management company, Express Scrips, showed that $55.8 billion was spent unnecessarily on higher-priced medications when more affordable, similar drugs could have been used. 

POSTED: Thursday, March 13, 2014, 5:30 AM
Filed Under: Michael Cohen

Over-the-counter (OTC) liquid medicines can be found in practically every household. They are commonly used for children or adults who have difficulty swallowing pills. In some cases, the medicine itself is absorbed better and faster in a liquid form, so even people who do not have difficulty swallowing pills might use liquid medicines.

Surprisingly, so far there isn’t a standard way for drug manufacturers to state the dosage measure for OTC liquid medicines. Both the directions for use and the markings on a dosing syringe, cup, spoon, or dropper may include one or more of these volume measurements:

  • Household measurements, such as teaspoons (tsp) or tablespoons (tbsp)
  • Metric measurements, such as milliliters (mL) or cubic centimeters (cc)
  • Apothecary measurements, such as drams (dr or ʒ) or ounces (oz or ℥)
  • Other measurements, such as drops (gtts) or dropperfuls

If these volume measurements are confused with each other, too much or too little of the medicine can be given. Many errors happen where the dosing directions recommend a teaspoonful but the dosing cup that comes with the product is marked not only in teaspoons but also tablespoons, milliliters, drams and ounces and the patient uses an incorrect measure.

POSTED: Thursday, March 6, 2014, 9:13 AM
Filed Under: Daniel Hoffman

Recently there's been some discussion in pharma's higher circles that biosimilars may not offer the road to riches along the lines touted by the industry's C-suite officers.  It is becoming increasingly clear that only a few companies may make substantial profits in that area and, in fact, biosimilars may actually represent a "fool's gold" for most pharmas.

Even as biosimilars aren't likely to be pharma's road to enormous profits, the recent events concerning Russia's incursion in the Ukraine open a light of reality into another of the industry’s illusions, this one involving the golden mountain of Emerging Markets.

It now appears that none of the BRIC countries that supposedly are the spearhead of pharma’s Emerging Markets strategy are meeting expectations.  China’s growth is slowing, the government is exercising price controls on drugs and they intend to grow their domestic pharma companies at the expense of foreign multinationals.  India and Brazil are even more aggressive at controlling prices, with India declaring compulsory licensing (i.e., breaking the patents) on several brands.  

About this blog

Check Up covers major health events in our region and offers everything from personal health advice to an expert look at health reform. Read about some of our bloggers here.

For Inquirer.com. Portions of this blog may also be found in the Inquirer's Sunday Health Section

Michael Cohen id the president of the Institute for Safe Medication Practices in Horsham.

Daniel Hoffman is the president of Pharmaceutical Business Research Associates (PBRA) in Glenmoore, Pennsylvania, a healthcare research and consulting company specializing in key account positioning and messaging.

Michael Cohen
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