s A Fresh Look at Health Insurance | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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A Fresh Look at Health Insurance

Neil Johnston

articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

Suddenly, health insurance issues are under the spotlight here in Australia through a survey published in the “Australian Health Review” May edition (The Journal of the Australian Healthcare & Hospitals Association, published by the CSIRO).
 The survey indicates that a fresh approach needs to be taken in regard to patient reimbursement for pharmaceuticals, particularly in the high-cost, non-PBS area.
Australian Health Review thanked Ken Gray from the Pharmacy Guild of Australia (Victoria Branch) for his support in the steering committee, and Roche Products (Australia) Pty Ltd (Dee Why, NSW) for providing an unrestricted research grant to carry out this study.
The unrestricted research grant was paid to the Peter MacCallum Cancer Centre and this was utilised to fund a part-time research officer to complete the project.

Roche manufactures some high cost pharmaceuticals, particularly in the anti-cancer category.
Below are the relevant media excerpts and i2P have asked Mark Coleman to research some of these health insurance issues and make relevant comments.

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Extract from Australian Health Review May 2011

Australian Health Review 35(2) 204-210 doi:10.1071/AH10894
Submitted: 28 February 2010  Accepted: 8 September 2010   Published: 25 May 2011

A survey of reimbursement practices of private health insurance companies for pharmaceuticals not covered under the Pharmaceutical Benefits Scheme 2008

Senthil M. Lingaratnam A E, Sue W. Kirsa A, James D. Mellor A, John Jackson B, Wallace Crellin C, Michael Fitzsimons D and John R. Zalcberg C


A
Pharmacy Department, Peter MacCallum Cancer Centre, St Andrew’s Place, Melbourne, VIC 3002, Australia. Email: sue.kirsa@petermac.org; dan.mellor@petermac.org
B
APHS Pharmacy, 6 Dividend Street, Mansfield, QLD 4122, Australia. Email: john.jackson@aphs.com.au
C
Peter MacCallum Cancer Centre, St Andrew’s Place, Melbourne, VIC 3002, Australia. Email: whc@melbpc.org.au; john.zalcberg@petermac.org
D
Medicines Australia, Level 1, 16 Napier Close, Deakin, ACT 2600, Australia. Email: michael.fitzsimons@medicinesaustralia.com.au
E
Corresponding author. Email: senthil.lingaratnam@petermac.org

Conclusion
Accessibility to pharmaceuticals remains an issue in healthcare with the cost to consumers for pharmaceuticals continuing to increase. Private Health Insurance companies may pay some or all of the costs of pharmaceuticals that are not reimbursed by the Commonwealth Government. How Private Health Insurance companies handle requests for high-cost pharmaceuticals in excess of the defined benefit limits is neither consistent across the major funds nor transparent to consumers.
Our findings suggest that if Private Health Insurance is to offer more equitable access to high-cost non-PBS pharmaceuticals, companies will need to be better informed of the clinical benefit and cost-effectiveness of these pharmaceuticals and must be assured that the risks associated with each application are equitably borne by all stakeholders; health insurers, hospitals, pharmaceutical industry, consumers and government alike.

Extract from Pharmacy News

Guild president calls for mandatory pharmaceutical cover
By Nick O'Donoghue on  26 May 2011

Australia needs to rethink its approach to insurance coverage for non-PBS medicines, experts believe.

Kos Sclavos, national president of the Pharmacy Guild of Australia, said this year’s decision by the federal government to defer several new PBS listings emphasised the need for private health insurers to provide mandatory pharmaceutical cover as part of policies.

Most insurers currently offered pharmaceutical benefits as an extra package on top of policies, he said.

Mr Sclavos was commenting on the results of a survey published in the Australian Health Review, which found inconsistencies in the manner in which insurers handle requests for high-cost pharmaceuticals.

Mark Coleman

I have been asked to comment on the above media excerpts and I offer the following observations.
The way prices have been moving incessantly upwards in regard to pharmaceuticals is simply stating the obvious.
High costs in pharmaceuticals means patients without sufficient means begin to “cherry pick” their prescriptions or simply do not have them dispensed at all.
This type of issue becomes a delayed health cost in the form of an expensive hospital admission down the track. It damages both the patient’s health and the budgets for the various hospitals and agencies that have to meet the acute and chronic care outcomes.
The concern of the Pharmacy Guild of Australia appears to relate to delays being created in PBS listings, that have further created financial pressure on patients.
A far cry from the original government objective of creating a universal health system that was affordable for all, that commenced with free PBS drugs and free doctor visits (and simultaneously destroyed pharmacist counter prescribing and compounding- the hidden primary care system provided by pharmacists at a low cost and universally valued by patients).

There is no easy answer to the problem of health funding of any description.
Any economist will tell you, cost insulation leads to higher consumption—and therefore upward pressure on health insurance costs.
Traditional insurance, to the extent that it insulates the patient from almost all costs, will eventually adopt access restrictions and even price controls just like government-run plans.
And that development destroys the basic principle of patient control over their health choices.
This reality applies to any funding source be it PBS, Medicare or private insurers such as Medibank, HCF or MBF.
In Australia, our health insurance model is a mix of Public-Private investment, or more correctly, a government-imposed, public-private model.
The rising cost of health insurance—which is a function of higher health care spending—exacerbates the problem of the uninsured or under-insured.
That, in turn, leads to politicians proposing a range of “solutions” to reduce the number of uninsured. But those solutions often rely on government restrictions and regulations to make health insurance fit the politicians’ notion of the way a health insurance market should work.

The idea underlying the public-private model is a system where private sector coverage still plays a role—how important a role depends on who is proposing the plan and the restrictions imposed—but the government has a very heavy hand in developing coverage packages and overseeing, regulating and even financing the system, so much so that it can be hard to tell where the private sector stops and the government begins.

What is needed is a consumer driven model that tries to find a way to put the patient in charge of most or all of their health care decisions.

This model has been developed in the US and it usually includes at least two components: health insurance for large expenses, while routine and preventive care is financed out of personal funds, including a tax-favoured Health Savings Account (HSA), Health Reimbursement Arrangement (HRA) or a Flexible Spending Account (ideally, without the use-it-or-lose-it provision).
The idea is to give patients more control over their money for many of the routine health care decisions, while ensuring they are protected from large, catastrophic claims. Many of these accounts have employer contributions or matching government funds.
An insurance-reimbursement arrangement such as the above would immediately give the patient a choice of provider – doctor, pharmacist or clinical nurse consultant, and would immediately bring the treatment of minor complaints within the ambit of pharmacists and nurses.
The informal counter-prescribing system that existed in pharmacy pre-PBS was a good one in that the pharmacy was always the first port of call, with referrals being made if a patient presented beyond the expertise of the pharmacist.
Doctors even competed for pharmacist referrals.
Some pharmacists developed enormous private practices and shipped their dispensed personal prescription formulas all over the country.
Mail-order pharmacy is not a new phenomenon.
One hidden benefit (to the patient) of the system was that because dispensing was a high gross margin enterprise, pharmacists would give extended credit to needy patients. It usually took the form of a perpetual credit account with the patient paying amounts they could afford periodically. The really needy had their accounts written off after 12 months- this was not a major burden to the pharmacies of that time. That is, pharmacists were part-funders of the Australian health system.

One of the selling points by government to pharmacists to encourage their adoption of a single funder PBS system was that bad debts would be eliminated and cash flow would increase because of guaranteed payments.
Today, many pharmacists would have a jaundiced view of that “benefit”.

So I would say that an opportunity exists to assist pharmacy patients through a creative budgeting process extended with high-end private insurance.
And that would introduce genuine competition between various channels of heath providers.
It would also give pharmacists the chance to regain control of their own profession once again if they were to adapt the pre-PBS model that once existed and generated enormous goodwill with pharmacy patients.
It would also provide employment for more clinical pharmacists and solve the over-supply of under-utilised pharmacists.

Is the wheel beginning to turn in pharmacy’s direction?

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