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N E W Y O R K C I T Y P H A R M A C I S T S S O C I E T Y

President’s Message

VOLUME 25, ISSUE 4 PSSNY hELPLINE 1-800-632-8822 MAY/JUNE 2016The Voice of Pharmacy in the Big Apple www.NYCPS.org

Dear members – This is my final column as NYCPS President. It’s a chance to look back and reflect on what we’ve accomplished

together in the past two years. At our upcoming PSSNY Annual Convention, my term as president will be completed and Parthiv Shah will be installed as NYCPS President. I wish Parthiv much success in his term as NYCPS President and I am confident in his taking over our organization. Looking back, when I accepted the role of President, I did so with the hope of helping us strengthen our collective voice in Albany on behalf of legislation

affecting us and our patients and customers. And I’m very happy to say, we’ve made considerable progress. I’m grateful for the tremendous support I’ve received -- not only from our NYCPS leadership and board of directors, but from so many of our members. The result seems clear: we’ve become an even stronger NYCPS. Just consider the many ways in which we’ve advanced:• Greater professional participation, with

more members now than when I took office.

Our voice in Albany these days is louder and more persuasive than ever. Our Lobby Days have been very effective!

continued on page 25

OFFICERSRon DelGaudio, President 718-230-3535Parthiv Shah, President Elect 718-292-4244Aniedi Etuk, Vice-President 212-222-3652Bill Scheer, Treasurer 917-805-4207Jim Schiffer, Secretary 212-616-7069

BOARD OF DIRECTORSAlex Perchuk, Chairman 718-835-2000Charles Catalano 718-358-1300Mike Agovino 718-543-3116Charlie Ciaccio 718-452-3261Vito Columbo 718-418-9700Jim DeTura 718-292-1856Aneidi Etuk 212-222-3652Russell Gellis 212-877-3480Carol Georgiadis 718-762-7111Roy Greif 718-363-3300Robert hopkins 516-852-1405Ray Macioci 718-823-1085Boris Mantell 347-276-5566John Navarra 212-213-5570Joseph Navarra 212-213-5570Boris Natenzon 718-720-3710Roger J. Pagenelli 718-364-6100Dhiren Patel 212-281-0488Richard Schirripa 646-590-1154

PSSNY REGIONAL REPSParthiv Shah BronxDhiren Patel ManhattanBoris Natenzon Brooklyn, Staten IslandRobert hopkins Queens

RECORDING SECRETARY, ACTINGMike Agovino 718-543-3116

NEWSLETTERJim Schiffer, Senior Editor 212-616-7069Designed, Printed & Mailed by: PPM 631-231-7300

IN THIS ISSUEPresident’s Message ......................1

Just When I Thought I Had Seen It All .............................1

Message from NYCPS Incoming President Parthiv Shah ...................3

Treasurer’s Report ..........................4

A Message & Greetings from PSSNY Exeuctive Director ...............4

A Message from PSSNY President Roger Paganelli ...............6

Secretary’s Report ..........................8

NPCA ..........................................10

ISMP ...........................................11

PAAS...........................................11

News from Around the Pharmacy World ...........................12

Retail Council...............................21

RX and the Law ...........................23

If there Is a “d” or “Vd” on your label... you’re delIquent or Very delIquent. please remIt.

for further InformatIon call 1-800-632-8822

The New York City Pharmacists Society111 Broadway, Suite 2002, New York, NY 10006

ADDRESS SERVICE REQUESTED

Each year in May, I think about the thousands of pharmacy students graduating this month and that reminds me of my own graduation—now 24 years ago. I’ve been in and around pharmacy for almost 35 years and just when I thought I had seen everything, a New Orleans investigative reporter has shown me—nope, you can still be shocked. Lee Zurik, an award-winning investigative reporter for Fox 8 TV news in New Orleans has done a series of stories over the past week on PBM consumer copay clawbacks. Be more specific, you might say, since PBMs claw back money from pharmacies in a variety of ways. Zurik’s investigation has focused on the practices of the

Late Breaking UpdatesP a g e 3

pssnY president’s Message

P a g e 6

nCpa reviews FULP a g e 1 0


Just When I Thought I Had Seen It All

MAY/JUNE 2016 NYCPS NEWSLETTER

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NYCPS NEWSLETTER MAY/JUNE 2016 PAGE 3

It is my pleasure to bid you all the warmest of welcomes. I am writing to you as the incoming President of NYCPS. The journey has been long and difficult, but I would not change a single thing. My parents came from India with only seven dollars and had to work multiple jobs to remain afloat. They had to overcome the language barrier, economic hardship, and the prejudice of the time. My father, Dipak Shah, worked two jobs and raised a young family, all while studying for his NABPLEX exam. I have been in a pharmacy since I was 6 years old, when my father opened his first pharmacy in 1984. My parents would bring me there every Saturday with my bag of toys, eventually leading to my high school years when I started working there. I did deliveries, stocked the shelves, ran the lottery machine, and at the end of the day, moped the floors. I worked at Saldo Drugs every weekend while in high school and continued even after I graduated St John’s University in 2001. I stayed focused and pushed forward, motivated and inspired by my father, who never took a day off. Even when my dad had kidney stone surgery, he was back to work the next day. He was always committed and passionate about pharmacy. I knew at a very young age my father was a giver, as he would give his all to the pharmacy, the family, and the community he loved. Similarly, my cousin Atulbhai, attended St. John’s University Pharmacy and graduated in 1992. Atul and the family stayed with us for a few years as I saw the level of dedication he had in completing pharmacy school. He would attend classes during the day and work a second shift at Roche Pharma in the evening. He later opened several pharmacies of his own and served as chairman of IAPS. I appreciate the continual support from IAPS and its Board. Having one role model is great, but having two role models is stellar. I knew I had to achieve and give more than those who came before me. I remember the exact moment I was on call with Bill Scheer, asking him about a pharmacy vendor, Telemanager. I wanted to get his opinion on the service

and we ended up talking about the pharmacy industry for an hour. At the conclusion of our call, Bill invited me to an NYCPS meeting. At the time, he was president of PSSNY and after one meeting in a room with greatness, I was hooked. The NYCPS board members were all givers, who worked very hard to pass legislation, raise RX PAC money and memberships, stop medicaid cuts, and still dedicate time to their respective businesses and families. I had never seen that level of laser sharp focus, dedication, and generosity, leaving me perplexed as to how they accomplished everything they sought out to do. As we built rapport, I set the same goals for myself. I am grateful to Jim Detura for asking me on to the NYCPS board. Enough about me and lets focus on you. I am here to ask, how may the NYCPS/PSSNY help you? How may we recruit more members and raise RX PAC money? How do we increase attendance at the conventions? What do you seek from the Society? I am eager to learn so that I may serve you better; therefore, please send me an email at [email protected]. I will try best to offer you more information on how to grow your business, your team, and build your profits. I believe in a community approach to overcoming our obstacles, and although the everyday struggle is difficult, it only means we need to grow stronger. I would like to focus on what affects our bottom line, because life is about progress and as pharmacists, we need to continue to serve the patients. What we can do together now will only create a stronger society for us all in the future. Remember, our state society, PSSNY is over 137 years old. There have been many people who have sacrificed for our profession and we all need to do the same. We must think like givers rather than takers, because positive thinking, combined with staying focused on the big picture will be our keys to success. There are more positive conditions in our industry than negative; therefore, we are exactly where we need to be. There will always be solutions to our obstacles; we just need to keep searching and march on. I am humbled to serve as the First Indian President of NYCPS. I thank my family, friends, my incredible staff/team, my children, my beautiful wife Vaishali, and the GIVERS who have served on both boards in the past and now! Thank you!

~ Parthiv Shah

Message froM NYCPs INCoMINg PresIdeNtParthIv shah


This June at the PSSNY Convention in Rye Brook, Westchester County, there will be a new New York City Pharmacists Society President installed. Our current Chairman ends his two year term and our current President Ron DelGaudio moves to the Chairman position , our first Indo American President, Parthiv Shah will begin his two year term as NYCPS president. Parthiv comes to the office having been seasoned with his ongoing work on the boards of both PSSNY and NYCPS and he has pharmacy in his blood, growing up in his dad’s pharmacy. Our successes of the past few years have been spearheaded by a dynamic team of leaders, who have been able to secure legislative successes for all pharmacists through hard work and a perseverance that has allowed issues of great importance to community pharmacists to be heard and rectified. The

new executive board has expressed their commitment to using the voice of the biggest affiliate in New York to rack up more wins for community pharmacy. To stay relevant in this fast changing environment we need to be aware of all that affects our profession, our businesses. The board and officers of NYCPS are dedicated to keeping community pharmacy updated, so you can respond correctly. I welcome Parthiv, a well qualified advocate for pharmacy. I would hope as many of our members as possible will attend the upcoming PSSNY convention, many interesting seminars will be held on everything from Pain Management to the Value Based payment system which will affect everyone. It’s also a good chance to meet the board members and your PSSNY representatives and find out all the latest happenings. Again good luck to Parthiv Shah as he takes over a leadership role of our organization, which has become a vibrant and effective voice for pharmacists in New York City. We are looking forward to an active and involved President, moving pharmacy forward in a challenging time.

- Bill Scheer, R.Ph. ©2016, Bill Scheer

Treasurer’s CornerChaNgINg LeadershIP at NYCPs

More than 350 community pharmacists gathered on May 24th and 25th in Washington, D.C., for the NCPA 2016 Congressional Pharmacy Summit to advocate for pharmacy choice for patients and greater drug transparency. I had the privilege to be among them. We attended panel discussions on the legislative outlook, lobbying 101, and a lively discussion on DIR fees. After the workshops, attendees conducted 600+ visits to more than 250 U.S. House and Senate offices. The New York group visited 15 offices including Senators Schumer and Gillibrand. We advocated for:• Creating greater transparency for generic prescription

drug reimbursements in government-run programs by enacting H.R. 244, the MAC Transparency Act;

• Requiring Medicare Part D and pharmacy benefit manager (PBM) corporations to report pharmacy price concessions (DIR fees) when prescription drugs are dispensed;

• Pushing to include an any willing pharmacy provision in federal programs by enacting H.R. 793 / S. 1190, the Ensuring Seniors Access to Local Pharmacies Act, which would allow community pharmacies in medically underserved areas to serve Medicare Part D beneficiaries as long as the pharmacy accepts the drug plan’s terms and conditions; and

• Increasing Medicare beneficiary access to health care services delivered by pharmacists by recognizing them as health care providers under Medicare Part B by enacting H.R. 592 / S. 314, the Pharmacy and Medically Underserved Areas Enhancement Act.

PSSNY member Steve Giroux and several Western New Yorkers met with Representative Pete Sessions (R-Texas) for an unheard of 1 ½ hours. Sessions is the Chairman of the Rules Committee—the most powerful committee in the House of Representatives! Being asked by the NCPA to conduct this meeting is an enormous honor and a tremendous vote of confidence in Steve Giroux’s ability to get the message delivered. The Rules Committee has two broad categories of jurisdiction: special orders for the consideration of legislation (known as “special rules” or “rules”) and original jurisdiction matters. A special rule provides the terms and conditions of debate on a measure or matter.

a Message & greetINgs froM PssNY

exeCutIve dIreCtor



As I enter the last 30 days of my one year term as PSSNY President, I reflect back on a year that seemed to go by so quickly for PSSNY, but I realize how much work was accomplished. We started last June without an Executive Director, but were deep into the search for a new hire. I spent many days in Albany transitioning from former ED to myself as interim ED and from president elect to president. Our building, laden with debt, was in contract to be sold and we anxiously awaited our closing date. We were planning our PSSNY Board retreat and scheduling board meetings for the coming year. I was contemplating committee selections and deciding on chairs and members of each. Planning to attend national and local (NYS) meetings, two conventions and some regional affiliate programs. Attempting to put a budget together with the finance committee, etc... The search committee ultimately landed on Kathy Febraio as our new ED and by November we finally had someone in the office full time who was at the helm and ready to steer the PSSNY ship onto a steady course for the duration of my tenure.

By the time Kathy took office in November, our board was well into it’s first half year of business. The building was sold and we were now happy tenants instead of being a miserable landlord. Our focus going forward was to make PSSNY a stronger and more relevant pharmacist society for our members and create new opportunities to attract more pharmacist members. I’m extremely proud to report to our members that in fact we are a better, stronger and more relevant professional organization due to all of the hard work and commitment from our board, staff and affiliate support. Our mid winter convention in Saratoga proved to be more successful than years past in many ways. For the first time in PSSNY history, all seven of the NYS pharmacy colleges were represented by a group of smart, energetic and committed pharmacy students. Thanks go out to our wholesaler partners and affiliates that made that possible. The student programming was masterfully executed with the first ever competitions created by our own NYCPS board member, Stephanie Alvarez. There was an opportunity for some NYCPS board members/store owners to address the entire audience of pharmacy students. Ray, Ron and Russell gave the students a 411 on “pharmacy in the real world” and they absolutely ate it up. The CE programs were all well attended and the casino night was a huge hit. The bottom line was that PSSNY and it’s dynamic convention committee led by Steve Moore, were able to make a record profit on the midwinter event, which as I said earlier just solidifies how much stronger a society we have become and tells the story of our relevance and where PSSNY is headed in the future. This past week, the last full week of May, I attended the lobbying day of the NCPA legislative conference and met with legislators and staffers in Washington DC for a day of lobbying. As usual, we were well received and had an opportunity to voice our issues that concern us on a national level. This coming Friday, June 3rd, I will attend the pharmacy conference in Albany to represent PSSNY as president for the last time of my term. The legislative session in NYS will end in June, so the legislative committee, PSSNY staff and all of our support team has their work cut out for them. We will continue with our calls to legislators, conferences with lobbyists, to push forward to pass our Fair Audit bill. At the same time, we are making a push for convention registration hoping to attract as many pharmacists in NYS to make our convention a success. I look forward to passing the baton to a very capable Russell Gellis as the new president of PSSNY on June 25 at the Westchester Hilton in Rye Brook, NY. I’d like to thank all of those that supported me during my presidency including my board of directors, the staff of PSSNY, Ray Macioci, my partners and my family. I look forward to my new position as Chairman of the PSSNY board for the 2016/17 year.

Thank you,~ Roger Paganelli , PSSNY President

a Message froM PssNY PresIdeNt roger PagaNeLLI

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As we approach our upcoming PSSNY Annual Convention which is taking place June 24 through the 26th, at the Westchester Hilton Hotel located in Rye Brook New York, it gives me the chance to go over some of the issues facing today’s pharmacists and pharmacy owners and the need to stay involved and educated in the operation of our pharmacies. In the past few months I have written about the Abbot lawsuit against pharmacies and suppliers who allegedly are distributing and selling at retail and on insurance plans, the imported and NOT INTENDED FOR SALE IN THE UNITED STATES Free Style and Free Style Lite Blood Glucose Strips. It is time to give an important update on this matter. This federal lawsuit was initiated in the Federal Eastern District of New York back in October 2015. Initially it was brought against about 2 dozen secondary suppliers of the Free Style strips and an equal amount of New York based pharmacies who got caught selling such strips to undercover retail shoppers on behalf of Abbott. It is important to note that pharmacy owners are also personally included and listed as defendants in addition to their pharmacies as this is considered a RICO –Conspiracy civil lawsuit which permits the plaintiff (in this case Abbott) to bring in the responsible parties as defendants. RICO cases also have the unique ability to demand all defendants share in financial exposure not just the amount of damages their participation has allegedly caused. So those with more assets (deeper pockets) have more risk and more exposure even if their participation in this matter was very limited. One more issue to report. Abbott has requested and received permission from the Court to share the information on all subpoenaed pharmacies with Abbott’s trading partners. Who is Abbott’s trading partners? CVS Caremark, Express Scripts, Optum, MedImpact and others who are ultimately collecting rebate dollars from Abbott on the sale of Free Style blood glucose strips for their various health plan sponsoring groups. Why share that information? SO that these trading partner PBMs can then conduct audits on their pharmacies who have been subpoenaed to help recovery improper payments for past billings by such pharmacies for un-rebateable purchases of Free Style strips which were then billed by these pharmacies as if the products were eligible for such rebates (the full retail priced packages of strips are eligible

for rebates). As you may recall many of the PBMs already are conducting audits on such blood glucose strip sales, recovering improper payments and then terminating such pharmacies from their respective pharmacy networks for at least a year for such illegal sales. Will these pharmacies get back into their respective PBM networks at the end of the one year period? I have no idea? But they can apply after a 1 year prohibition. Fast forward to May 2016. The case has expanded to nearly 400 defendants, (secondary suppliers and pharmacies) and approximately 2,000 subpoenaed pharmacies, from coast to coast, including Hawaii, website operators and secondary suppliers. Pharmacy defendants are being asked for at least $10,000 from Abbott to be dismissed from the case some high purchasers are being asked for upwards of $26,000 to be dismissed. Abbott (through their attorneys) claim that they do not intend to add any more defendants to the litigation. Currently this case has taken two twists. A pharmacy located in Greece (yes Greece the country) has been named as a defendant because the pharmacy sold Free Style strips over the internet, through sites such as Amazon and E Bay, (yes Amazon and EBay also received subpoenas from Abbott for their client records so that his how this pharmacy was included). The next twist is that a federal criminal grand jury has been assembled to review the alleged criminal behavior involved in this scheme. A Sunrise Florida based distributor of blood glucose strips is the focus of this grand jury. I am informed that at least one local Florida pharmacy has received a subpoena for records related to this criminal grand jury matter. All of the information above means that you as a pharmacist or pharmacy owner must be prudent in where you purchase your drugs and supplies. The Food and Drug Administration is now enforcing the Track and Trace legislation to confirm security in the pharmaceutical marketplace. However the Track and Trace rules and regulations DO NOT PERTAIN TO MEDICAL SUPPLIES. Which means that there are holes in the system for selling such products and we as pharmacists must be cautious and vigilant not to get tangled up in improper distribution schemes. The old saying if it sounds too good to be true and looks too good to be true, then stay away. I have spoken to a few pharmacists who got dragged into this Abbott suit as defendants. They swear up and down that they never authorized the suppliers to sell foreign Free Style Strips to them. They also said once and a while if they ordered 24 boxes of strips from the suppliers, maybe 4 or 5 boxes of European strips would be stuck in with the 18 or 19 legitimate boxes by the supplier. Who needs this headache? The collateral damage for you as a pharmacist is to be involved in a PBM audit because your pharmacy

se C r e T a r y’sreporT MAY/JUNE

2016



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I received an email recently from a pharmacy student working at an independent pharmacy. He wrote about his concerns for the bad things happening in independent pharmacy now, like slow and low MAC payment updates and DIR fees. Despite the problems, this next generation of pharmacists is on fire to become independent pharmacy owners. The dream is still alive. The dream of pharmacy ownership is one that many pharmacists can identify with. That aspiration is still going strong in thousands of staff pharmacists and pharmacy students despite the difficult environment created by PBMs. In March NCPA conducted its first NCPA Pharmacy Ownership Workshop, sponsored by McKesson, of the year. In the 26 years since NCPA created and began offering the Ownership Workshop, over 2,000 pharmacists have gone through the program. About half of those attendees have gone on to start or buy an existing pharmacy. I’ve been to a number of these Workshops over the years and the enthusiasm from these young pharmacists is off the charts! Some of the attendees are starting a new pharmacy from scratch. Some of the attendees are disgruntled chain pharmacists looking for something different. Sometimes the current owner and the aspiring owner attend the Workshop together. Most of them have identified the site of the pharmacy they will start or they are working with the current owner who has agreed to sell his/her store to them. No one is naïve to the challenges. No one is naïve to the risk. But the obstacles are offset by the potential for working for yourself and creating jobs while caring

for the people in your community or building on the legacy that the current owner started. The Ownership Workshop is the centerpiece of the pharmacy ownership tools that NCPA offers. Sometimes the multi-faceted legislative and regulatory resources NCPA is well known for overshadows the gold mine of tools available to past, present, and future pharmacy owners. From the first day of pharmacy school to making the decision to ride off into the sunset, NCPA has specific tools to offer available to NCPA members at every stage of their career. Because of the problems with reimbursement and the significant payment reform transitioning to a value-based payment system, which is affecting how all health care providers, including pharmacists, are getting paid, it’s more important than ever for new owners to be well trained and made aware of the opportunities as well as the hurdles they will encounter. All the more reason that future owners launch their careers loaded with information from the Ownership Workshop and the resources NCPA provides to give them continued guidance throughout their career to keep a step ahead of the competition. For those of you who are thinking about or know someone thinking about starting or buying a pharmacy, there will be two more Ownership Workshops this year, June 3-5 in Memphis and Oct 13-15 at NCPA’s Annual Convention in New Orleans.

- B. Douglas Hoey, RPh, MBANational Community Pharmacists Association CEO

No stoPPINg theM Now

appeared as a subpoenaed party or defendant in this mess. Bad enough your pharmacy may have to pay Abbott to get out of the case, but a more damaging outcome is a possible termination (which is increasingly common) for selling such illegal and non rebatable strips to PBM patients. (Yes, it has happened to scores of pharmacies across the country.)

Next item to alert you to is to also be careful if you receive a phone call from some alleged patient or caregiver asking to purchase bulk quantity of strips from your pharmacy using a telephone called in credit card number. You may be getting snagged into another trick. People are buying strips from unsuspecting pharmacies, using phony credit cards which initially process but then upon bank review, get rejected as a fraud.

In closing, I do hope to see everyone at the upcoming PSSNY Convention. Every time I attend it, I find it valuable to learn what is going on in the pharmacy profession from my colleagues and it is nice to renew friendships as we all work too damn hard. Mark the date (June 24th through June 26th) and plan on attending. For details call 800 632 8822 and see www.pssny.org.

- Jim Schiffer, Secretary NYCPS

Secretary’s ReportFrom page 8


The pharmacy heard Xanax. A 15-year-old boy with Autism was prescribed TENEX (guanFACINE), a drug indicated to treat attention deficit and hyperactivity dis-order (ADHD). The prescriber called in the prescrip-tion for Tenex along with 3 other medications. Accord-ing to the prescriber, the pharmacy made a mistake when interpreting her telephone order and dispensed the anxiolytic agent XANAX (ALPRAZolam). Adding to the potential for confusion of these two sound-alike drug names is the fact that both Tenex and Xanax are available in 1 and 2 mg dosage strengths. The boy’s mother caught the error when she reviewed her son’s medication after arriving home from the pharmacy. When taking verbal orders, pharmacy staff should perform a read back (and spell back for drugs that are known to cause confusion) of the medication name, strength, dose, and frequency of administration for verification. When leaving voice mail prescriptions, the

prescriber should spell out the drug name (e.g., T-E-N-E-X) and use single digit affirmation of the dose (e.g., one – five instead of fifteen) with confused drug names and doses. Another strategy to prevent this error is to use both brand and generic names when prescribing these drugs. Additionally, pharmacists should always review the patient’s profile. In the case above, the patient had Tenex, not Xanax, on his profile which may have prompted the pharmacist to contact the prescriber to clarify the prescription. It is great that the mother checked her son’s medications at home and caught the error. Pharmacy staff can help en-courage patients and caregivers to check prescriptions by reviewing the medications at the point-of-sale. This will help catch medication errors before they leave the pharmacy and avoid the need for the patient or care-giver to make a return trip to the store. Ultimately, this makes for safer care and more satisfied customers.

MedIcATIon SAfeTy • PrevenTIng errorSBy the Institute for Safe Medication Practices“Have you experienced a medication error or close call? Report such incidents in confidence to the ISMP National Medication Errors Reporting Program (ISMP MERP) at 1-800-FAIL-SAF(E) or online at www.ismp.org to activate an alert system that reaches manufactur-ers, the medical community, and FDA. ISMP guarantees confidentiality of information received and respects reporters’ wishes as to the level of detail included in publications.”


Many pharmacies have used the “Kindly Oblige With” (KOW) inventory trade as a method for supplying inventory they do not have in stock. PAAS reminds pharmacies that this type of exchange leaves pharmacies vulnerable to invoice shortages and potentially can result in contract termination if the pharmacy does not have and retain adequate proof of purchase information. In addition, unless you are providing just enough to supply for a specific patient, you are now (as of March 1, 2016) responsible for compliance with the Drug Supply Chain Security Act (DSCSA) “Track and Trace” requirements that include the 3 T’s – transaction information, transaction statement and transaction history. PAAS National® has seen multiple large recoupments and a termination notice recently stemming from invoice audits conducted by Prime Therapeutics. The issue for the pharmacies effected is that they were buying or trading inventory with other pharmacies. Prime has decided to not accept anything that does not come from a wholesaler or manufacturer

and is citing their provider manual as the reason. Drug and Supply Requirements

Participating Pharmacies must purchase all medications and supplies being dispensed to Covered Persons from verifiable licensed wholesalers. The ordering of these medications and supplies must be tracked using verifiable wholesale invoices and pedigree invoices (when required by applicable law). Prime reserves the right to not accept documentation from any wholesalers at any time when the invoice documentation cannot be verified.

PAAS wants to remind pharmacies that with the Drug Supply Chain Security Act, if you do continue to purchase or trade medications from other pharmacies, you have additional requirements to follow. However, we strongly discourage this practice on a routine basis due to the recoupments we have seen. If you have any questions email PAAS National® at [email protected] or call 888-870-7227.

Kow INveNtorY trades & CoNtraCt terMINatIoN


Jim Schiffer reporting...news from Around

The Pharmacy World

MAy/JUne 2016 edITIonNCPA Annual Legislative/Lobbying Event May 24th and 25th was the dates for the Annual NCPA Legislative/Lobbying Conference held at the Double Tree Hotel in Crystal City, Arlington Virginia, just outside of the Pentagon. I have attended scores of these annual lobbying events going back to the early 1980s, when I began my crusade to make the federal government make crimes against pharmacies and pharmacists a federal offense. The tone at this year’s event - - in my opinion - -can be summed up in a few words, apprehension about the future. In no time in the past has pharmacy been under such tremendous pressure from all sides, government investigations, commercial audits, HIPAA audits, and compliance reviews by state Medicaid authorities and intense audits conducted by the various health insurance companies and the Pharmacy Benefit Managers. On top of these issues are the additional pressures, such as underpayments by the PBMs, as well as the Medicare Part D Prescription Drug Plans for both brand name and generic drugs. Throw in the DIR (Direct and Indirect Remuneration charges) which are hidden for weeks and sometimes months at a time. DIR fees are most commonly found in select Medicare Part D plans, and have no rhyme or reason in their application. Some such DIR fees are associated with generic substitution rates (requiring at least 94% generic compliance a yet to be defined term of art), as well as star ratings evaluations as a basis for assessing such fees. I learned at the NCPA Conference that one pharmacist from the mid-west found a 85% DIR charge for his dispensing of Ery-Tab tablets on a Medicare Part D plan. He lost several hundred dollars on that prescription and was scratching his head about the rational. Who will lead this country for the next four years as our president? Will it be Donald Trump or Hillary Clinton? While I do not want to get into personal politics in this publication, it seems that both major candidates

have baggage in their candidacy. Who will look after the pharmacy profession Hillary or Donald? Good question and traveling to Washington for this meeting, I did not get any sense of what will happen under either scenario.

Developments in Medicare Parts B and D The Centers for Medicare and Medicaid Services back in March had proposed a change to the reimbursement for physician administered medications paid for under Part B. There is a barn storm of protests from the physician and patient communities regarding the proposed change. Commercials are running on the New York radio stations supporting the maintenance of the existing program under the “Community Oncology Alliance”. Senators and Congressmen and women numbering 250 are supporting status quo on this change. According to CMS documents, currently Medicare Part B generally pays physicians and hospital outpatient departments the average sales price of a drug, plus a 6 percent add-on. The proposed changes would test whether changing the add-on payment to 2.5 percent markup plus a flat fee payment of $16.80 per drug per day which does change prescribing incentives and according to CMS, would lead to improved quality and value. CMS would update the flat fee at the beginning of each year by the percentage increase in the consumer price index for medical care for the most recent 12-month period. This test would begin in late 2016 (no earlier than 60 days after the rule is finalized). The independent Medicare Payment Advisory Commission (MedPAC) described a nearly identical formula back in June 2015 in their report to Congress. CMS expects that the add-on payment of 2.5 percent plus a flat $16.80 fee will cover the cost of any drug paid under Medicare Part B. The flat fee is calculated such that it is budget neutral in aggregate. CMS intends for the test to result in savings through changes in prescribers’ behavior. The word on the street is that physicians will reject this formula and force patients to hospitals and


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medical centers for the more exotic (and more expensive) treatments. CMS believes that there is a relationship between physician drug selection and profit to the physician. Physicians often can choose among several drugs to treat a patient, and the current Medicare Part B drug payment methodology can penalize doctors for selecting lower-cost drugs, even when these drugs are as good or better for patients based on the evidence. To illustrate the effect of this change, consider two drugs each prescribed for a similar condition, with similar patient outcomes, but with widely varying prices. The average sales price for Drug A is $5, and for

Drug B it’s $100. Today, Drug A is paid at $0.30 above the price of the drug and Drug B at $6.00. But under this proposal, Medicare would pay Drug A at $16.93 above the average sales price and Drug B at $19.30. Fourteen republican senators have written to the CMS acting director, Andrew Slavitt telling Mr. Slavitt why the new proposed payment plan is flawed. Interesting that physicians get the support of the congressional leaders but when pharmacy and pharmacists cry for help with Medicare Part D, the congressional leadership seems to be insensitive and unresponsive. Some Democratic senators and congressmen and women are joining ranks with their Republican comrades, including Senator Cory Booker of New Jersey.

I don’t think the folks in congress really understand real world issues, and this is pretty much in line with my beliefs. Meanwhile pharmacists cannot even get meaningful price updates on generic drugs under Part D prescription plans.

News about Wal Mart as they try to Keep Up with others Wal Mart has been struggling to maintain their market share for some time. Now with some changes in their grocery unit, they are onto something new. It seems that Wal Mart is making changes in a significant number of their super center stores. Wal Mart has dedicated an entire section to organic produce, fresh sushi and a selection of about 50 gourmet cheeses, all of these changes as

the result of a scouting trip for Wal Mart management through Europe during 2015. In the old format, Wal Mart would have a cold case of packaged deli meats — now there’s a charcuterie section. The supermarket section of the store layout is more appetizing: Roma tomatoes tumble down angled displays that make it easier to see what’s available and honey crisp apples beckon from farmer’s market-style crates. This new format of Walmart’s are supposed to be the leading edge of what could become a grocery revolution at the giant retailer — and probably one of the main reasons that Walmart’s food sales were a significant factor in the company’s most recent quarterly earnings report which pleased Wall Street folks. Additionally most of Walmart’s produce and bakery departments will be upgraded to make them more attractive and easy

Around the PharmacyFrom page 12



to navigate, with some surprising options for Walmart, the country’s largest retail discounter. Walmart is trying to give traditional grocery retailers like Kroger and also high end grocers like Whole Foods a challenge to their dominance in the retail food marketplace. If things work out according to Walmart plans, Walmart is hoping to steal grocery shoppers away from mid-level chains including Kroger, Safeway, Wegmans and Aldi — and then even grab some customers from Whole Foods — and at the same time have a positive effect on Walmart’s current weak sales numbers. Currently Walmart has 3,465 supercenters and 633 smaller Neighborhood Markets in the U.S. where the initiatives will eventually show up. Earlier this year, Walmart

announced the closing of nearly all of their mini stores known as Walmart Express. Additionally on top of the closing of nearly all154 Walmart Express centers, Walmart closed an additional 52 traditional Walmart stores. Why you may ask? The Express Stores did not fit in well with the Walmart super center strategy and were losing money, the remaining closed locations were just not profitable. The Walmart supply chain system is optimized for the large retail supercenter,” according to an analyst with Kantar Retail, as it was explained to Supermarket News in early 2015. “It can work reasonably well for a Neighborhood Market of 38,000 to 42,000 square feet. But when you keep going down in size, eventually it’s going to become an issue.”

Drug Chain Update CVS Health stock took a hit once the number crunchers reviewed

the inclusion of the former Target pharmacies into the mix. I heard from one of the staff pharmacists that Target Pharmacies were generally slow in sales and unprofitable, hence Target dumped them in CVS lap. CVS is doing their best to bring them to a profitable level. In the meantime investors are not impressed with the Target acquisition. I hear that other chains are struggling as well. Wegman’s sent out a mailer to my home offering our household five $20 coupons off of groceries (one for each transferred Rx to a Wegmans Pharmacy). According to folks I spoke to under anonymity, Wegman’s is considering spinning off the pharmacies or just closing them if they are not able to generate a return on their investment for the space they are taking up in the supermarkets. I remember my friend from Pharmacy College, who was a Pathmark pharmacy




manager for many years. Pathmark management constantly complained about the weak profit margins in the pharmacy department. At one time the CEO of Pathmark had suggested that the pharmacy departments would be more profitable if they were turned into an Asian food take out department. Imagine if Pathmark was still in business today, what would the CEO say of today’s margins? Moving on to the pending Wal-green’s acquisition of Rite Aid, I would not bet the ranch that this deal is all set to occur. If you recall, sev-eral large mergers have been turned away by the United States Justice De-partment, including the most recent rejection of Staples merger with Of-fice Depot. It seems that the Obama administration is getting tough on such business consolidations as the

government finally believes that such mergers are not good for the consum-ers. The Rite Aid/ Walgreens merger is now under extended FTC/ Justice Department analysis and there is no definite date for such completion. Meanwhile the stock price of Rite Aid continues to erode as it has dropped from a peak of $8.18 to in Mid April to $7.75 on 6/3/2016, and the late Octo-ber 2015 announcement of the Wal-green’s takeover is now clouded with doubt. Time will tell and we should see some additional guidance in the next 60 days or so.

Pharmaceutical Industry Updates Pfizer presented their reasons on June 8th for their intended sale in the United States of a new version of oxycodone before the Food and Drug Administration in a Joint Meeting of the Anesthetic and Analgesic Drug Products Advisory Committee and the Drug Safety and Risk Manage-

ment Advisory Committee. This pre-sentation before these two commit-tees Pfizer will be asked to discuss new drug application (NDA) 207621, oxycodone hydrochloride and nal-trexone hydrochloride extended-re-lease capsules, submitted by Pfizer, Inc., with the proposed indication of management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. The product is an ex-tended-release formulation intended to have abuse-deterrent properties based on the presence of naltrexone, an opioid antagonist, in the formula-tion. The committees will be asked to discuss whether the data submitted by the Applicant are sufficient to sup-port labeling of the product with the properties expected to deter abuse. Bloomberg Business Week has done an expose in their May 23 edi-tion of their weekly magazine, on




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the state of pharmaceutical compa-nies and the related charges for their drugs. The focus of this examination started on Turing Pharmaceuticals, but there are plenty of other pharma-ceutical giants who are taking advan-tage of this interesting twist in patient access to high priced medications. Pharmaceuticals. All three pharma-ceutical manufacturers have jacked up prices for their medications and at the same time the industry has cre-ated these charitable companies to help patients navigate through the outrageous cost of such medications. Have you heard of PSI or PAN both of which are charity organizations with major funding from the drug in-dustry? PSI’ revenue in 2015 was a measly $ PSI was founded in 1970 to improve reproductive health using commercial marketing strategies. For its first 15 years, PSI worked mostly in family planning (hence the name Population Services Internation-al). According to their website PSI was started in 1985, initially it was promoting oral rehydration therapy. PSI’s first HIV prevention project — which promoted abstinence, fidelity and condoms — began in 1988. PSI added malaria and safe water to its portfolio in the 1990s and tuberculo-sis in 2004. This is a nonprofit com-pany which accepts donations from governments, corporations and pri-vate individuals and assists patients with access to certain expensive and needed medications. The largest charity which handles pharmaceuti-cal grants for patients in need is the PAN Foundation. PAN stands for Pa-tient Assistance Network Foundation and it took in more than $800 million last year of which 95% came from pharmaceutical industry donations. In a nutshell, a pharma company can raise the hell out of a drug, and then as a token of good faith make a con-

tribution to one of these charitable companies to help administer grants to patients in need of their medica-tion. Another such charitable com-pany is known as CDF, which stands for Chronic Disease Fund. All of these charities apparently are there to serve the pharmaceutical industry and dole out grants to patients in true need of such medications but are not financially able to handle the out of pocket costs. Medicare prohibits discount coupons to be used on the Part D program so the drug industry has found a cottage industry to help get the expensive medications in the hands of Medicare patients without the need of a coupon as the grants are permitted by medicare for patient use. The Hepatitis C drugs such as Harvoni and are taking advantage of these grants for patients enrolled in the Medicare Part D program. As this concept is rather complex, for more information search the Bloomberg Business Week article, entitled, “Big Pharma is here to help you help them make a bunch of money through charities that make them look good”. These charities are helping jack up the price of medications to the citi-zens of this country. What we need is for congress to reign in these pric-ing gimmicks and eliminate this type of behavior in the industry it is costing everyone precious health care dollars as it is today.

The Hospital Picture in the Metropolitan New York Area For decades we have known that hospitals needed to realign their operations in order to stay profitable. It started during the Regan administration when Medicare began a revision to hospital reimbursement and instead of paying like patients were admitted to a hotel, Medicare began paying based on patient’s diagnosis and related predictable lengths of stay depending upon the patient ailment or disease state. As

a result most hospitals throughout this country had an overabundance of unused hospital beds. Hospitals have had to redesign their operations to adapt to the new outpatient based mentality. In the meantime, large New York City based hospitals continue to spread their wings. NYU Langone Medical Center has signed a 30-year, lease for Columbia Property Trust’s entire 25-story building at 222 East 41st Street, in midtown near the Queens Midtown Tunnel Manhattan portal. Once completed the building will house a combination of medical offices and ambulatory care facilities in the building. NYU Langone’s main medical center campus is located between First Avenue and the FDR Drive from East 30th to East 33rd Streets. Details of the overall cost of this project are not public. NYU Langone will operate brand new outpatient offices, medical suites for physicians in the nearly 400,000 square foot building located between Second Avenue and Tunnel Exit Street. Construction on this project will start around the end of this year, following the October expiration of law firm Jones Day’s 353,541-square-foot lease. NYU Langone will occupy the lobby, common areas and the parking garage in addition to all 25 floors. Then we have news that MD Anderson, the Texas based cancer hospital is joining forces with the New Jersey based Summit Medical Group in a joint operation in Florham Park, New Jersey. The 130,000-square-foot facility will be located at 150 Park Ave., next to the state-of-the-art 100,000-square-foot Summit Medical Group facility, which opened last summer. This new medical facility is scheduled to open sometime in mid-2017.The intention of this joint venture is that it will be the hub of ambulatory care for the Summit Medical Group. The new medical facility will be developed by the Rockefeller Group,




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and will include surgical, radiation and medical oncology, as well as imaging devices, a molecular lab and a pharmacy. The facility — located in Florham Park in a development known as “The Green” — will provide for a combination of patient education, patient care services, clinical research and clinical trials. Then we go to the boroughs of New York City, like Manhattan, Brooklyn, Queens and the Bronx, where the nonprofit hospitals and medical centers are bleeding money like crazy. Since 2000, 19 hospitals in the New York City five boroughs have closed. There still exists an excess of hospital beds for our population. In the borough of Manhattan, it averages 6 beds per 1,000 people living in Manhattan. In the outer boroughs, the average is 3 beds per 1,000 people (and that includes Westchester County too). The national average of

hospital beds per 1,000 people is a mere 2.3 hospital beds. Why do we have so many beds in New York City, especially in Manhattan, (hospitals don’t like to give up territory). In the meantime the losses will continue and unless real reform is established, we will see more shutdowns as we did in Brooklyn with Victory Memorial Hospital, and Long Island College Hospital, Caledonian Hospital, Interfaith (second campus), and St. Mary’s Hospital. In Staten Island St. Vincent’s Hospital closed, and in Manhattan, both of the St. Vincent Hospital campuses closed along with Mother Cabrini Medical Center. The Bronx lost Westchester Square and North General Hospitals. With all of these closings we still have too many hospital beds in the city. We need a real reform attempt to maintain emergency room care but not the bloated hospital/hotel rooms which are associated with such current institutions. What is the answer? We need to get the brightest minds

in health care to sit in a room and work out a solution to the issues. Plus someone has to face the music that Medicaid patients in New York City receive substandard health care. No matter what the politicians claim, the pharmacist is on the front lines and they can evaluate the way their patients are treated at the local store front Medicaid centers. Folks it is time to close this issue of News from Around the Pharmacy World. BY the time the next issue comes out it will be the national conventions for the Republican and Democratic candidates for president. The way I see it, we will all need clothes pins to hold our noses when we vote in November for president. Nobody is appetizing at this time. Nobody. Hope to see everyone at the Annual PSSNY Convention and Trade show, June 24th to 26th in Rye New York.

Stay well, ~ Jim Schiffer

©2016 James R. Schiffer

Every once in a while a business owner swipes a card and an unusual

message appears on their terminal screen telling them not to return the card to the customer. The reason for this “pick up” message could be that the credit card was reported stolen or a payment is extremely overdue. If you receive a pick up card response, which may be displayed as “PICUP” or “PIC UP” on your terminal’s display window, or the Authorization Center tells you to take the card, follow the instructions. You may be eligible for a cash reward from your credit card processor for doing so. To collect your reward, simply cut the card in half directly through the entire account number. Place the card in an envelope along with your name, merchant number, date of pick up, and your address and mail it to your credit card processor (check your card acceptance guide for the appropriate address). Never put yourself or staff in danger by insisting on keeping a card if the customer becomes agitated or

threatening. Use your best judgement. Call your processor to learn more about pick up requirements. Better yet, why not join the Retail Council and utilize our credit card processing program where you’ll have convenient access to our experts who can answer questions about this and many other topics? For a nominal dues payment, your membership in the Retail Council is a great complement to the continuing education and other services you receive through NYCPS and PSSNY. In addition to our competitive credit card processing service, the Council also has a great workers’ compensation program, which can save pharmacies up to 50 percent or more on this mandatory insurance. More than 170 independent pharmacies in New York State are already participants because the savings is difficult to beat! Contact Nicholl or Carly of the Council for your free, no-obligation savings analysis at (800) 442-3589 or [email protected]. You can learn more about the Retail Council and its programs by visiting www.retailcouncilnys.com.

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This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and the New York City Pharmacists Society through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

A lot has been written about quality processes in the dispensing function and many good ideas are out there; the Two Dosage Unit rule, shelf talkers, NDC checks, etc. But one thing that isn’t often talked about is getting the right prescription to the right patient. All of the safety and quality processes go for naught if the prescription is given to the incorrect patient. Consider these two examples. Tom Smith comes into Anytown Pharmacy to pick up his wife’s prescription. In the will-call bin with her prescription was also one for Ron Smith. The technician thought Tom had said Ron and assumed that the second prescription was his. She gave Tom both prescriptions. The error was discovered when Tom returned home. Paul was making a delivery for City Pharmacy one afternoon and pulled into a driveway shared by 101 and 103 Main Street. Mary was standing in the driveway. “You got here just in time; I’m headed out for my doctor’s appointment.” Paul ignored his normal protocol at the insistence of the patient. He gave the prescriptions to Mary who left for her appointment. Paul discovered later that the prescriptions were for a patient who lived at 103, but Mary lived at 101. Many times pharmacists don’t think about the actual hand-off to patients. They would be surprised to learn what happens at the delivery point. For example; patients step forward when someone else’s name is called, patients or staff hear names incorrectly, patients with the same or similar names appear at the pharmacy at the same time, or patients in the same extended family with the same name utilize the same pharmacy. Unfortunately, claims history tells us that these patients are very likely to take the medications that they go home with or get delivered to them. This occurs even when their name isn’t on the label, they have never heard of the drug or their own doctor’s name is not on the prescription. Also unfortunately, juries are less inclined to place blame on the patient for these sorts of mishaps. Fair or not, the responsibility falls on the pharmacy to get the right medication to the right patient. A number of solutions are available. Previous articles have extolled the value, to both the patient and the pharmacist, of patient counseling.

This article won’t repeat all of those benefits, but patient counseling is an effective tool to discover errors at the time of delivery. But patient counseling is not always needed or required, so we need other tools. Asking the patient to produce identification and requiring the staff to review prior to handing over the medications is one method. Others have asked the patient for a second identifier to differentiate patients with similar names; address, phone number or social security number. This has to be done as discreetly as possible to protect the patient’s privacy. It is also helpful to ask additional questions of persons picking up others’ prescriptions; what is their relationship to the patient or ask some of the secondary identifiers above. Delivery drivers should never deviate from their protocols and should verify the address and identity of the patient when delivering medications. Date, time and to whom the medications were delivered should all be documented. Most of the time, delivery to the patient is not a problem, so little attention is paid to it. But, ignoring this step of the dispensing process creates a weak point in the pharmacy’s overall quality initiative. History shows us that patients will take whatever medication is given to them, even when it makes no rational sense to do so. It is essential that this final step in the dispensing process gets the same attention as other steps in the process. Once the medication is in the wrong hands, it is impossible to predict the outcome.

1. Tug Valley Pharmacy, LLC, et al. v. All Plaintiffs below in Mingo County Cases, No 14-0144 (Supreme Court of Appeals of West Virginia, May 13, 2015.) 2. Orzel v. Scott Drug Co., 537 N.W.2d 208, 213 (Mich. 1995.)

© Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company.

This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.


PBM charging the patient a copay, paying the pharmacy a miserly low fee, and then clawing back the rest of the copay the patient paid. Here’s the math using an example from the segment: Medication cost .............. $4.92 Pharmacy fee ................. $1.75 Patent copay ................ $11.67 Amount paid .................($5.00) The PBM “clawed back” $5 by charging a copay $5 higher than what the PBM paid the pharmacy and later, taking the $5 back from the pharmacy. Another way of looking at it is that the consumer is charged more than what the pharmacy is paid. The pharmacy is used as a collection agency for the PBM. It’s outrageous PBM behavior and it’s not new. It has become more prominent though in recent years. We sent letters to Optum and Catamaran complaining about the copay clawbacks and their MAC lists which were resulting in below pharmacy cost payments at a much higher rate than other PBMs. We also talked with CMS and members of Congress. However, the vast majority of examples of consumer copay clawbacks have taken place outside of government programs. The news segments from Fox 8 New Orleans have been excellent in the way they have plainly described the practice and how patients and pharmacists are affected. Note that the identity of the pharmacist is obscured and his voice altered—like a “60 Minutes” interview with an undercover agent—to shield his identity because of fear of PBM retaliation. Sad. Most of the content from the segments won’t surprise community pharmacists, but one statement from an Optum spokesman made my jaw drop. “OptumRx’s Pharmacy Reim-bursement Overpayment Program

helps ensure the millions of people we serve have affordable access to the drugs they need.” Let’s dissect the absurdity of this statement a little more. In the example mentioned above, out of the $11.67 that the patient paid, the pharmacist was paid $4.92 to cover the cost of the medication plus a $1.75 dispensing fee. Where did any “overpayment” occur? In the buck seventy-five dispensing fee? UnitedHealth, the parent of OptumRx, paid $12.8 billion for Catamaran just last year, which is probably a better indicator of where Optum’s pharmacy “overpayments” are really going. So what could fix this problem? One of the segments includes an interview with Sen. Bill Cassidy (R-La.), a physician who expresses shock over the practice. See for yourself. Normally, I prefer the government stay out of legitimate business relationships but, unfortunately, the relationship between PBMs and retail pharmacies is a one-sided power grab. Federal legislation such as H.R. 244, the MAC

Transparency bill, is needed. On the DIR front, NCPA continues to lead community pharmacy’s advocacy in urging CMS to finalize the DIR Rule and enforce the new MAC regulations in Part D. Louisiana’s state insurance commissioner, Jim Donelon, is also interviewed in one of the segments and expresses his concern over this practice. NCPA recently submitted comments and testified to the National Association of Insurance Commissioners on its Health Carrier Prescription Drug Benefit Management Model Act. The WVUE Fox 8 series on consumer copay clawbacks is one to remember. In the opening, Zurik asks an 11-year old what is the definition of a “copay”. She did a good job defining what it should mean. Unfortunately, in the PBM’s dictionary, copay sometimes means “full pay—and then some”.

- By B. Douglas Hoey, RPh, MBANational Community

Pharmacists Association CEO

Seen It AllFrom page 1


PSSNY Executive DirectorFrom page 4

The Committee has the authority to do virtually anything during the course of consideration of a measure, including deeming it passed. The Committee can also include a self-executed amendment which could rewrite parts of a bill, or the entire measure. In essence, so long as a majority of the House is willing to vote for a special rule, there is little that the Rules Committee cannot do. Thank you, Steve for carrying the message for community pharmacy to this very important Congressman! The issues we addressed in Washington are ones PSSNY deals with frequently: phone calls, emails and faxes arrive daily emphasizing the impact these matters have on our members. New York’s federal representatives are very powerful individuals and we need to

let them know our position on these bills. Unfortunately, we were a small group of people and that limited the number of visits we could schedule. In some meetings, there were no constituents, but NCPA agreed we needed to talk to them regardless. Solving pharmacy’s issues with the PBMs needs to be a joint effort between the state and national organizations.

You still have an opportunity to participate through the NCPA’s Legislative Action Center. Please support our in-person advocacy efforts with your virtual ones. http://www.ncpanet.org/advocacy/grassroots-resources/action-center

Thank You. - Kathy Febraio, CAP

PSSNY Executive Director

• More pharmacy students, successfully engaged! This initiative has brought us more younger members – an encouraging sign for the future.

• Defeated Implementation of AAC/COD, protecting us from reimbursement cuts and the related DOH monitoring process was a terrible burden to comply with for all pharmacy owners on an ongoing basis.

• We’ve fostered Buying Groups, in order to create new money-saving purchase opportunities for our members.

• A major victory: passage of the MAC APPEALS BILL!

• We’ve held very successful Conventions, both mid-year and annual.

• Thanks to the active involvement of so many of you as members, we’ve seen some very effective Lobby Days in Albany.

• Currently, we’re focused on developing a Fair Audit reform bill and pushing for its passage into law.

• Among our other projects...immunization reform and the expansion of our scope … and our push for CDTM collaboration.

• We’ve also been working with the New York City Department of Health and Mental Hygiene to allow independent pharmacies throughout NYC to dispense Naloxone without a prescription, to combat opioid overdose.

• Of course, we still steadily serve our communities each day, with our presence on the front lines against such threats as the Ebola and Zika viruses. We recently gained approval to distribute free insect repellent to our pregnant customers, as we deem appropriate.

Whew! As I look back on the past two years, I’m impressed by the scope of our shared achievements. I certainly want to express my deep thanks to Kathy our ED at PSSNY … to the leadership and entire staff of PSSNY and to our New York City Board Members. As I now prepare to move from President to Chairman, I’m delighted to welcome Parthiv Shah, a second

generation pharmacist who’s been serving on our board since 2007. When you read his story elsewhere in this newsletter, you’ll see that his life story echoes the promise of the American Dream. I’m proud to have him as my successor. As incoming NYCPS Chairman, I ask of each of you what I also ask of myself: your continued devotion to the profession we share … to the difference we make in people’s lives … and to an ongoing commitment to be an active participant in PSSNY. We’ll continue to make even more progress – with new members and new opportunities – if we all keep doing our best. I hope to see all of you at the upcoming PSSNY Convention in Rye New York, June 24th through the 26th! Thanks everyone, for a great two years as President! Thank you,

~ Ron Del Gaudio, R.Ph.NYCPS President

President’s MessageFrom page 1

Larry Doud Kathy Febraio Joe Brennan Steve Moore RDC PSSNY Executive Director RDC RSSNY Board Member


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Drug name fields on pre-scription. A patient brought a new computer-generated prescription (Figure 1) to the community phar-macy. The pharmacy technician processed the prescription as oxy-CODONE 30 mg tablets, missing that “OXYCONTIN” was printed immediately below. The pharmacist also missed that OxyCONTIN was indicated so he verified and then dispensed oxyCODONE. The fact that the presentation of the generic name oxyCODONE did not include the modifier “extended release” likely contributed to the technician

and pharmacist interpreting the prescription as oxyCODONE rath-er than OxyCONTIN (oxyCODONE extended release). The customer called the phar-macy because the tablets ap-peared to be different than what he had received in the past. A different pharmacist reviewed the original prescription and discovered that the patient should have received OxyCONTIN 30 mg. The patient returned the bottle and the pre-scription was corrected. The phar-macist also contacted the physician to provide valuable feedback about the error and how the presentation of the drug names on the comput-er-generated prescription contribut-

ed to the error. We invite all prac-titioners to report errors and close calls that may have occurred with e-prescribing systems to the ISMP National Medication Errors Report-ing Program (https://www.ismp.org/merp). We will notify others and ad-vocate for standards that include incorporating safety into e-prescrib-ing and EHR systems.

Figure 1. Confusing presentation of drug names on electronically-gen-erated prescription: oxyCODONE above OxyCONTIN.

ISMPFrom page 11


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