Comments on Drug Channels: Fresh DEA News from Cardinal

With all the divertion hoopla,perhaps it may behoo...

2008-02-27T17:35:00.000-05:00

With all the divertion hoopla,perhaps it may behoove the DEA to put tracking devices on those hi-jacked tracker-trailers-one of which last month left unaccounted >20,000,000 hydrocodone bitartrate Tabs.

Ok, Jim, I'll bite: What is the "rest of the story...

2008-02-27T08:48:00.000-05:00

Ok, Jim, I'll bite: What is the "rest of the story?"

Feel free to email me if you'd like to share something off-the-record.

Adam

too bad you don't know "The Rest of the Story"Jim

2008-02-27T08:44:00.000-05:00

too bad you don't know "The Rest of the Story"

Jim

Cardinal has been in trouble in the past for numer...

2008-02-08T15:39:00.000-05:00

Cardinal has been in trouble in the past for numerous situations and I am not a huge fan however I think this has become more of a witch hunt. There is no way a wholesale can determine what "every" customer is doing even if a customer is flagged by the wholesaler- it is impossible. I think the focus should be more on the physician who is writing the script to be filled.
In addition, there are some true issues of pain management and if the physician and pharmacy check and fill, why should Cardinal be to blame? We should concentrate more on real issue which is physicians wrongfully writing phony scripts.

Tom,I see your point, but your example (90% CDS, l...

2008-02-08T10:04:00.000-05:00

Tom,

I see your point, but your example (90% CDS, lots of generics) represents a hypothetical, easy-to-spot situation. In practice, the large wholesalers have 10,000 or more active customer accounts placing millions of total orders per year. The challenge comes from sorting the customers and/or orders into three groups:
1. Non-purchasers, i.e., no diversion
2. Possible purchase for diversion
3. Purchase for diversion (your example)

While groups 1 & 3 might be easy to spot, there are probably many orders that will fall into a fuzzy middle area. Hence Cardinal’s discussion of software solutions to flag problems.

While I agree a supplier should "exercise diligence and caution," I am not aware of formal rules or guidelines to define the *level* of diligence or caution, especially for orders in the fuzzy middle. Perhaps these issues will become clear if we find out exactly what actions (or non-actions) led the DEA to suspend Cardinal's licenses.

A

"How much responsibility should a wholesaler have ...

2008-02-07T20:47:00.000-05:00

"How much responsibility should a wholesaler have for the behavior of its customers?" Good question.

Thirty years ago your primary wholesaler sent a rep into your pharmacy once a week. That guy (they were all men and they all wore neckties and suits or at least sport coats) knew what your store was doing and if he caught a whiff that something funny was going on, he passed the word up the ladder to the warehouse manager who would call his connection at the state board or division of drug control who would then make a visit and inspection. And if your CDS purchases exceeded some kind of base percentage, the wholesaler would make a call to the board and you'd get inspected. If you were running a clean store, you had nothing to worry about.

Today, you might see a wholesaler rep in your store once a quarter and since they've all gone regional, the warehouse VP probably doesn't even know how to reach the state boards in any state but the one he's in.

So if a pharmacy is doing $40K a month with a wholesale facility and 90% of that is CDS, but most of that is generic (generating higher profits) it's entirely possible the facility would rather not "rock the boat" and jeopardize the good numbers the pharmacy is generating for that facility.

Of course, I may be totally off-base speculating about the motives of my hypothetical wholesaler. But retail pharmacists are expected to exercise diligence and caution about the prescriptions we dispense--why not hold the wholesalers to a smilar standard?

Tom Connelly, RPh
Sun Pharmacy
Rising Sun, MD