Canadian Pharmacies Receive 30 Calls Daily for Nevada Prescription Rx Reimportation Program

The four Canadian online pharmacies licensed to sell prescription drugs to Nevada residents under a new state program each received an average of 30 telephone calls daily in the first month, and about one-third of the calls resulted in purchases, the Las Vegas Sun reports (Hansel, Las Vegas Sun, 6/6). Under the program, which was established under a state law enacted last year, Canadian pharmacists licensed by the Nevada State Board of Pharmacy can mail to state residents prescription drugs that appear in the Orange Book and HC-DPD, which list medications approved in the U.S. and Canada, respectively. Prescription drugs sold under the program must meet the manufacturing requirements of FDA and the Therapeutic Products Directorate of Health Canada; have a dosage that appears in the Orange Book and HC-DPD; and come from the onsite inventory systems of online Canadian pharmacies. In addition, Canadian pharmacists cannot mail prescription drugs in liquid, injectable or intravenous forms or medications that require refrigeration or other special handling during shipment. The state pharmacy board has inspected and approved four Canadian online pharmacies to participate in the program, and a Web site established by the state includes links to those pharmacies (Kaiser Daily Health Policy Report, 5/8). The Web site has received about 100,000 hits in the past month, the Sun reports.

Comments
David MacKay -- business director for Ultra Care Pharmacy, which participates in the program -- said that most of the telephone calls the pharmacy has received involved questions rather than purchases. MacKay said that some Nevada Medicare beneficiaries have used the program as an alternative to the prescription drug benefit. "We're seeing a return of patients who did join Medicare and are unhappy with the caveats and the devil in the details," he said. State Rep. Barbara Buckley (D) said that she expects a report on the program within the next few months. She added, "I've gotten calls and emails from a lot of people who say they are so glad this has finally gone through" (Las Vegas Sun, 6/6).

Editorial
"U.S. drug manufacturers have few, if any, reasons to control medication prices in this country," but the Nevada program that allows state residents to purchase prescription drugs from Canadian pharmacies might prompt such action, a Las Vegas Sun editorial states. "In the month since Nevadans could legally mail-order prescription drugs from Canadian pharmacies, hundreds of orders have been placed, and Canadian druggists are reaching out to not only seniors but also other groups that need medicines," the editorial states. According to the editorial, pharmaceutical companies might "find reasons" to reduce prescription drug prices "if enough Americans -- as individuals and business owners -- show they are sick of paying high prices for their medications and seek lower-cost alternatives elsewhere" (Las Vegas Sun, 6/8).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Massachusetts's Medicaid Program Overcharged CMS By $86.6 Million, HHS OIG Audit Says

Massachusetts's Medicaid program must repay the federal government $86.6 million for services related to targeted case management, according to an audit by the HHS Office of General, the Boston Globe reports. The HHS OIG conducted an audit of Massachusetts' Medicaid program's targeted case management division and found that the state charged CMS $171.2 million for unallowable services between 2001 and the first quarter of 2004. CMS paid about half that amount, or $86.6 million. Each of the reported violations involved state Medicaid officials billing CMS for case management provided by the state Department of Social Services that was not directly related to providing medical care. The audit documented "hundreds of thousands" of times when the state "overcharged Medicaid by amounts ranging from $209 to $295, the Globe reports. For example, the state billed CMS for a social worker who called a child's school, asking that he be allowed to return to class. HHS Inspector General Daniel Levinson in the report said, "We attribute these unallowable costs to the state agency's lack of procedures for ensuring compliance with Medicaid requirements." However, state Medicaid Director Beth Waldman said the state and federal government reached an agreement in 1994 that allows the billed services. Waldman said, "[I]f they want to change [the regulations], that's fine, but you can't do it retrospectively, and you can't do it through an audit." Waldman said she "would not be surprised" if the HHS OIG requires the state to pay the $86.6 million, at which point the state Legislature would consider ways to return the money. Levinson said the state also must work with the federal government to resolve another $27 million in disputed Medicaid charges, about half of which were paid by the federal government (Levenson, Boston Globe, 6/5).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Drug Ads Aimed At Cancer Patients Difficult To Read, Make More Appeals To Effectiveness Than Safety

Oncology drug advertisements that ran in patient-focused cancer magazines presented the drugs' benefits differently -- earlier in the advertisement text and in larger type size -- than their side effects or risks, according to an analysis by researchers at Dana-Farber Cancer Institute in Boston. The findings will be presented the American Society of Clinical Oncology's annual meeting in Atlanta.

"Direct-to-consumer advertising of oncology medications typically focuses on the drugs' benefits, as would be expected, but it does so in a manner that might lead some cancer patients to not appreciate equally the drugs' potential side effects and risks," says Gregory Abel, MD, MPH, the study's first author. "Oncology providers should be aware of these advertisement characteristics, as they may influence patients' perceptions of and requests for these medications."

Abel will present the data at a poster discussion session on Tuesday, June 6 at 8 a.m., Building A, Level 3, Room A 314.

The researchers reviewed all advertisements for oncology drugs that appeared in three cancer patient-focused magazines, CURE, Coping with Cancer and MAMM, in 2005. They analyzed the advertisement copy for readability using the Flesch Reading Ease measurement. They also assessed the type size and the placement of the benefits and side effects/risk information, as well as the advertisements' presentation of clinical trial data, apparent patient testimonials, images of patients, physicians and/or celebrities, and claims about effectiveness, social-psychological enhancements, ease of use, and/or safety.

A total of 75 medication-specific advertisements appeared in the magazines, but only 15 were unique, as some of the advertisements ran repeatedly during the year. The advertisements were found to be difficult to read overall, but the text outlining the benefits had the highest readability score. Information about the drugs' benefits, on average, appeared in the top third of the advertisement text, while descriptions of side effects and risks typically ran in the bottom third. Also, the largest type size of the text explaining the benefits was about twice as large as the largest text outlining side effects and risks. Interestingly, the amount of text devoted to benefits versus risks and side effects was roughly the same.

None of the advertisements included information about costs or contained celebrity or physician endorsements. About two-thirds (67 percent) referenced clinical data and 80 percent contained images of patients.

"We found that appeals to medication safety are infrequent in oncology print direct-to-consumer advertisements, while appeals to medication effectiveness are ubiquitous and often made through the presentation of clinical trial data," explains Abel, who is also an instructor in medicine at Harvard Medical School. "Such appeals to the scientific efficacy of cancer-related medicines, while suitable in the setting of clinical encounters, may not be appropriate when made directly to consumers via language that is difficult to read."

Bill Schaller
william_schaller@dfci.harvard.edu
Dana-Farber Cancer Institute
http://www.dfci.harvard.edu