United States Pharmacopeia Medication Research Articles

Third-party reimbursement for generic prescription drugs: The prevalence of below-cost reimbursement in an environment of maximum allowable cost–based reimbursement

ObjectivesTo examine average prescription gross margin (GM) for prescriptions and to evaluate the prevalence of below-cost reimbursement for generic prescriptions across different third-party payers and therapeutic categories. DesignA retrospective descriptive study using 2015 dispensing data from a single independently owned pharmacy in Iowa. To calculate GM, the pharmacy's actual acquisition cost was subtracted from the third-party reimbursement rate for each generic prescription. The frequency of negative GMs was calculated for the top 6 plans and the top 10 therapeutic categories by prescription volume. SettingA single, independently owned community pharmacy in Iowa. ParticipantsPrescription dispensing records for the pharmacy's largest private and public payers by prescription volume. InterventionGross margins were calculated on a payer and United States Pharmacopeia (USP) medication category level. Main outcome measuresGM for generic prescriptions reimbursed under cost for specific payers and USP medication categories. ResultsThe 2015 prescription volume for the study pharmacy was 70,866 prescriptions, of which 88% were generic. For all prescriptions, the mean GM was $6.63 per prescription, and the median GM was $3.49 per prescription. Generic medications had a mean GM of $4.66 (median, $2.86), and brand name medications had a mean GM of $21.83 (median, $16.15). The percentage of generic prescriptions paid below acquisition cost was 15.1% overall and ranged from 4.1% for Iowa Medicaid to 25.9% for one of the private payers. The most common USP medication category by prescription volume was cardiovascular agents, representing 25.2% of generic prescriptions. For the 10.9% of these prescriptions reimbursed below cost, the mean GM was –$6.80. The 2 USP medication categories with the largest negative mean GM for generic prescriptions were analgesics and anticonvulsants, with mean GMs of –$10.10 and –$11.30, respectively. ConclusionThe current maximum allowable cost–based reimbursement system often results in inadequate payment for generic prescription drugs. The amount of underpayment varies substantially by payer and therapeutic class.

Medication Errors Associated with Cerebyx; Consumer Safety with Creams and Ointments; Caution Regarding Color-Coded Eye Medications; Strength Misread as Total Dose

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR). Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or United States Pharmacopeia (USP) ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

Cross Contamination with Insulin Pens; Look-Alike Vials; Kids and Medication Patches; New Look-Alike Name Pair; Preventing Dosing Errors with Methotrexate Injection

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP tollfree, 24 hours a day, at 800-233-7767 (800-23-ERROR). Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or United States Pharmacopeia (USP) ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

Keeping Patients Safe from Iatrogenic Methadone Overdoses Final Curtain for IV Colchicine Overdoses

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR). Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or United States Pharmacopeia (USP) ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

Persistence Saves Patient's Life; Do Not Use Epidural Tubing for an Intravenous Solution; Topical Antiseptic Given Orally; Refrigerator Monitoring

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR). Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or United States Pharmacopeia (USP) ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

One Tablet or One Bottle? Avoiding Mix-Ups between Sterile Water and Sodium Chloride Bags a Chain is Only as Strong as its Weakest Link

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR). Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or United States Pharmacopeia (USP) ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

Errors with Injectable Medications: Unlabeled Syringes are Surprisingly Common; Unintended Consequences of High-Alert Stickers; Easily Misread Abbreviations

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP tollfree, 24 hours a day, at 800-233-7767 (800-23-ERROR). Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or United States Pharmacopeia (USP) ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

Preventing Mix-Ups between Various Formulations of Amphotericin B; Cardiac Catheterization Lab Error; Say Again?; Colchicine Deaths

These medication errors have occurred in health care facilities at least once. They will happen again-perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP tollfree, 24 hours a day, at 800-233-7767 (800-23-ERROR). Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or United States Pharmacopeia (USP) ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

Improving the safety of neuromuscular blocking agents: A statement from the USP Safe Medication Use Expert Committee

Recommendations of the interdisciplinary Safe Medication Use Expert Committee of the United States Pharmacopeia (USP) to assist health care professionals, manufacturers, and organizations in handling neuromuscular blocking agents (NMBAs) safely and effectively are discussed. Review and analysis of the USP Medication Errors Reporting Program and MEDMARX program databases showed a continuing risk of patient harm or death due to errors with NMBAs. Medication errors involving wrong concentrations, wrong doses, wrong drugs, look-alike packaging, and sound-alike names, combined with lack of monitoring and communication, have been associated with the use of NMBAs in health care institutions. Serious adverse events occur when NMBAs are used without adequate safeguards. Recommendations for improving safety were developed through review and discussion of root causes and areas of concern with these medications. Medical errors with NMBAs continue to result in patient morbidity and mortality. Increased awareness and action on the part of all parties involved are needed to improve the safety of this class of medications.

Usefulness of the USP Medication Counselling Behavior Guidelines

To assess the perceived usefulness of the United States Pharmacopeia (USP) Medication Counselling Behavior Guidelines among Finnish community pharmacists. The Guidelines were systematically disseminated to pharmacists through a 4-year project (TIPPA 2000-2003). A postal questionnaire was sent to a random sample (n = 734) of Finnish community pharmacists (response rate 51%). More than one quarter (27%) of the respondents was aware of the Guidelines. The Guidelines were made known to the respondents mostly via a book on patient counselling skills (41% of those knowing the Guidelines), continuing education (37%), and in-house training (28%). Over 60% of those who knew about the Guidelines regarded them as a good or very good instrument for learning the principles of patient counselling. The Guidelines were considered less useful as an instrument for the self-evaluation of performance in different settings. The results of this study indicate that even though the USP Guidelines have been promoted strongly through basic and continuing education during the TIPPA Project, more than half of the respondents were not aware of the Guidelines. The Guidelines were considered more useful in learning the principles of patient counselling than learning self-evaluation of performance.

Validation of the United States Pharmacopeia (USP) Medication Counselling Behaviour Guidelines

The aim of this study was to assess construct validity and internal consistency of the United States Pharmacopeia (USP)Medication Counselling Behaviour Guidelines.Thirty-six pharmacists from Maryland and Washington, DC, were recruited to evaluate six selected videotaped vignettes (n= 216) by using the 35-item Medication Counselling Behaviour Guidelines comprising four original subscales. The construct validity and internal consistency of the Guidelines were evaluated using factor analysis (principal component analysis) and Cronbach’s alpha. Statistical analysis indicated good construct validity and internal consistency of the Guidelines. Cronbach’s alpha for the whole original scale was 0.91 and for the four original subscales: Introduction 0.70,Content 0.86, Process 0.86 and Conclusion 0.80, respectively. Further analysis of the scale using factor analysis yielded four strong components that were interpreted as: needs assessment, precautions and warnings, management of the treatment and communication based on their content. This 4-component solution showed also high internal consistency. The USP Medication Counselling Behaviour Guidelines are a valid and reliable tool for evaluating patient counselling practices.

Medication errors in children: a descriptive summary of medication error reports submitted to the United States pharmacopeia

Background : Understanding where and how medication errors occur in the pediatric population can help raise awareness of potential and actual medication errors. In addition, this knowledge can contribute to the development of strategies to help improve the quality of health care in pediatric patients. Objective: To identify characteristics of medication errors in the pediatric population, we conducted a retrospective study of errors submitted by health care practitioners and other reporters to the United States Pharmacopeia's Medication Errors Reporting (MER) Program (presented in cooperation with the Institute for Safe Medication Practices) and to the USP MedMARx SM database. Methods: We performed a restrospective search for medication errors reported in the MER Program database from January 1, 1995, to December 31, 1999, and the MedMARx database from January 1, 1999, to December 31, 2000. Results: Pediatric patients were involved in 333 (9%) of 3818 error records submitted to the MER Program and in 1969 (5%) of 43,287 records submitted to the MedMARx database. In the MER Program, 104 (31%) of the 333 errors were cited as harmful or fatal, and 102 (5%) of the 1969 errors submitted to Med-MARx were cited as harmful. Improper dose/quantity was the most frequently reported type of pediatric error among the 337 types of errors identified in the MER Program (157 [47%]); of the 2003 type of errors identified in MedMARx, the most frequently reported types were omission (543 [27%]) and improper dose/quantity (494 [25%]). The products involved most often (eg, intravenous fluids, including both premixed and extemporaneously compounded preparations) were similar in the 2 programs. Conclusions: Our data suggests that pediatric patients may be more vulnerable to adverse outcomes from medication errors than adult patients. Further error prevention and reduction strategies should be developed for the pediatric population.