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Rauner announces changes to pharmacy oversight

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Responding to a Tribune investigation that found drugstores frequently failed to warn customers about potentially dangerous drug interactions, Gov. Bruce Rauner is unveiling a major plan designed to improve public safety at pharmacies throughout the state.

The administration’s proposal would require pharmacists to counsel patients about risky drug combinations and other significant issues when buying a medication for the first time or when a prescription changes. Illinois law now requires only that patients be offered counseling, a mandate often addressed at the cash register with a brief inquiry, such as: “Any questions for the pharmacist today?”

The governor also plans to beef up state oversight, including directing inspectors to put more emphasis on adverse drug reactions and launching a “mystery shopper” program to test how well pharmacists comply with the law. […]

A Walgreens spokesman said: “Our goal is to provide the highest level of care to patients, and we are supportive of the governor’s effort to further promote a culture of safety in community pharmacies.”

Rauner’s plans to use existing inspectors and new mystery shoppers to improve safety at Illinois pharmacies can be achieved through executive orders. But changing the counseling requirement would need the approval of a bipartisan House-Senate panel, as would his proposal to post signs in pharmacies with a consumer hotline along with information about a patient’s right to counseling.

I still don’t understand why these big pharmacy chains don’t have computer programs that can automatically cross-check a customer’s prescriptions for potential harmful interactions. Why are we relying on human memory here? Humans can make mistakes because they get too busy (on orders from on high) or whatever.

…Adding… The proposed additions are underlined along with stricken text…

Failing to provide ~~ensure that~~ patient counseling in accordance with this Part, failing to respond to requests for patient counseling, attempting to circumvent patient counseling requirements, or otherwise discouraging patients from receiving patient counseling concerning their prescription medications ~~is offered or refusing to respond to requests for patient counseling~~. […]

c) Every licensed pharmacy directly serving patients at a physical location must conspicuously post a sign provided by the Division containing a statement that the patient has the right to counseling, the Division’s consumer hotline number, information on how to file a complaint for failure to counsel, and any other information the Division deems appropriate. The sign must be printed in color ink or displayed electronically in color, measure at least 8 1⁄2 x 11 inches in size, and be posted at either a cashier counter or waiting area clearly visible to patients. Licensed pharmacies that do not maintain a physical location directly serving patients must include a copy of the sign within any dispensed prescriptions. The sign will be available to download on the Division’s website. […]

Nothing in this Section shall be construed as requiring a pharmacist to provide counseling when a patient or patient’s agent refuses such counseling. When a patient or patient’s agent refuses to accept patient counseling as provided in this Section, that refusal shall be documented. ~~The absence of any record of a refusal to accept the offer to counsel shall be presumed to signify that the offer was accepted and that counseling was provided.~~

posted by Rich Miller
Tuesday, Jan 24, 17 @ 9:50 am

Comments

correct, computer record is most accurate.

but customers are not reliable as they may have multiple prescription vendors or multiple docs or take OTC items (herbs/grapefruit juice) that could interfere with the script being picked up. a conversation offered might prompt a revelation.

Comment by Amalia Tuesday, Jan 24, 17 @ 9:55 am
Ok. Here’s the rub. You wait in line 10 minutes for your turn. The pharmacist gets to you and to counsel you, takes you to HIPPA proof room. 5 minutes to counsel. Now if you don’t understand English an interpreter has to be found. Gov Rauner, please let the experts handle this. You have no clue at the can of worms you are opening up.

Comment by blue dog dem Tuesday, Jan 24, 17 @ 9:57 am
this is not a business friendly regulation. it will increase pharmacy costs by requiring additional staff and delay customers. its also a bit of a nanny state approach.

Comment by Ghost Tuesday, Jan 24, 17 @ 10:06 am
I heard story a week or so ago. They had a big box pharmacist talking about how they were filling something like 600 prescriptions a day.

Most often, it has been a pharmacy tech who handles the bag when I pick up a prescription.

Comment by Huh? Tuesday, Jan 24, 17 @ 10:15 am
It is good the idea is out there. In this day and age of computers people who have mutiple prescriptions can be proactive as well. Don’t depend on your Dr or pharmacist, ask questions of both and follow up by reading the data sheetwith your prescriptions.

Comment by FormerParatrooper Tuesday, Jan 24, 17 @ 10:15 am
What about eliminating the practice of measuring how quickly pharmacists are able to get medication into the hands of patients? They’re professionals for goodness sake, not baristas or fast food employees.

Has anyone mentioned to Bruce that many pharmacists are in a union? For that matter, what group represents “mystery shoppers”?

Comment by Jocko Tuesday, Jan 24, 17 @ 10:16 am
So new government regulations and red tape on business aren’t always bad?

And new unfunded state mandates, such as requiring schools and daycare centers to test for lead in water, aren’t always bad, too?

They may actually serve common-sense, important public purposes, as in these two cases?

Remember that when the Usual Suspects start chanting shallow generalities about rolling back “regulations” and “unfunded mandates” as a “philosophy.”

If you have a beef with a particular regulation or mandate, lose your “philosopher” delusion and be specific in real-world, rubber-meets-the-road terms.

Comment by wordslinger Tuesday, Jan 24, 17 @ 10:17 am
More proof that one man’s consumer protection could well be another man’s business-unfriendly burdensome regulation.

Comment by Skeptic Tuesday, Jan 24, 17 @ 10:19 am
My younger niece is a 4th year pharmacy student at STLCOP, has worked part time at both independent and chain pharmacies as well as a hospital pharmacy as a tech. I forwarded the original Tribune report and she was shocked with the results.

While I applaud the intent of this proposal I do see problems with these changes as Amalia and blue dog have stated. Maybe my family has just been fortunate to have dealt with detail oriented pharmacists for so many years.

Comment by illini Tuesday, Jan 24, 17 @ 10:21 am
Rich,

As I was reading your post my first thought was for the insurance companies too. I realize not everyone has insurance but as the insurance companies enforce their requirements on what a doctor can prescribe for a patient and thrn recommends what alternative (cheaper) to prescribe, why not go one step further in their computer programs? I mean I could then have scripts at Walgreens, CVS, Walmart, etc., but with their master records they could at least compare and assist in that area - couldn’t they?

I thought of this last night too as I was picking up a much needed antibiotic from a 24-hour pharmacy (Walgreens) at 11 pm, for most of my scripts are at another (CVS). I was not in a good frame of mind and couldn’t recall a couple of the MEDS I take when I picked it up…

Of course it won’t work for everything, but it’s a “Baby Step…”

Comment by LINK Tuesday, Jan 24, 17 @ 10:23 am
The real world isnt so simplistic. Pharmacists dont know a patients medical history. This is over regulation. Rauner suddenly believes in govt…

Comment by Retiree Tuesday, Jan 24, 17 @ 10:31 am
Of course I can’t say for sure. But dealing with several different custom database-like packages through work, and seeing other things that have happened, I can say it can be surprisingly tough to make good software to do this sort of thing. Whether that’s because of the nature of the projects or some high risk of incompetence of software contractors I don’t know.

I could also see real problems with being able to help the software do its job. It would need constant updating as new drugs are released and guidelines are revised. That alone may add a lot of cost to the system. It would need to catch slightly different formulations with different names. As others mention, if you want to catch prescriptions from other docs you’d really need a nationalized database tracking all prescriptions from any doc. And of course you’re still vulnerable to what the patient actually does, whether it be taking alternative drugs or remedies, or not taking medications as directed (I’ve lost loved ones to both).

Totally agree something is better than nothing, so I’m glad they’re going to try. But I could believe some corporate folks see a much more intimidating task than we might.

Comment by Threepwood Tuesday, Jan 24, 17 @ 10:38 am
Isn’t this what your doctor is for? Shouldn’t your doctor know any adverse reactions from taking two or more prescriptions simultaneously? Next, your liquor store attendant will have to give you information regarding mixing your Budweiser and your oxy.

Comment by Ratso Rizzo Tuesday, Jan 24, 17 @ 10:42 am
If this is government overreach, who is supposed to be responsible for informing patients of potentially fatal drug interactions? Doctors aren’t well trained in that, so they can’t do it. Are people just supposed to look it up on the internet?

First of all, there’s a reason pharmacy school is a several year program - not all of these interactions are just going to pop up on google. Second, what about people who don’t have the English skills or internet access?

Point being - if we don’t force pharmacists to do it, are we ok with people dying of totally preventable drug interactions they couldn’t possibly have known about? What is the alternative here?

Comment by PJ Tuesday, Jan 24, 17 @ 10:43 am
A knee jerk reaction or planted fake news to look govenor like?

Comment by Rabid Tuesday, Jan 24, 17 @ 10:53 am
Honestly, I can’t get Drs and hospitals to stop trying to give me codeine for pain, even though it states very clearly in my chart “Allergic to Codeine” and I tell them every time when they ask my allergies. I don’t have a lot of faith that my pharmacy will do much better….

Comment by HangingOn Tuesday, Jan 24, 17 @ 10:54 am
Amalia, there is supposed to be an ongoing effort to create a health information exchange that would merge information from several sources. I went to the agency’s website via IL Gov list of agencies. This is all I found:

https://www.illinois.gov/sites/ilhie/Pages/default.aspx

I’m not impressed considering the years of study and funding provided by the Feds.

Comment by Norseman Tuesday, Jan 24, 17 @ 10:56 am
PJ. You are not wrong. But there are tremendous logistical considerations that should be adressed prior to script pickup. If the medical community refuses to readily share medical info on patients, it is impossible to rely on the memory of patients needing meds. A pharmacist is only as good as the information he is given. Every prescription I have picked up has been preceeded with the question, “have you, or you taking any other medications?”

Comment by blue dog dem Tuesday, Jan 24, 17 @ 10:58 am
Rich, the study says the warning messages do come up on the computer and there are so many warnings, not necessarily critical ones, that most pharmacists no longer pay attention. I believe the study recommended fewer and more pertinent warnings.

Also, they have a quota of perscriptions to fill in a specified time frame.

Comment by Union Dues Tuesday, Jan 24, 17 @ 10:58 am
Good effort, but patients should do their own research too, each time they are prescribed a new medication. And if you’re not sure, contact the doctor.

Comment by Cassandra Tuesday, Jan 24, 17 @ 10:58 am
–Honestly, I can’t get Drs and hospitals to stop trying to give me codeine for pain, even though it states very clearly in my chart “Allergic to Codeine” and I tell them every time when they ask my allergies.–

Prescription opiods are big business and a lot of doctors and hospitals have played ball, as we’ve learned to our sorrow in recent years.

Both the WSJ and NYT have done great work detailing how Big Pharma instituted marketing programs to load up docs with swag to push opiods.

That doesn’t even include the out-and-out “pain management” opiod strip-mall bazaars that have gotten people hooked all over the country.

Comment by wordslinger Tuesday, Jan 24, 17 @ 11:09 am
===Isn’t this what your doctor is for?===

To a point, yes. But pharmacists are the experts on this. I wouldn’t trust my GP to perform brain surgery.

Comment by Rich Miller Tuesday, Jan 24, 17 @ 11:10 am
Plus people have multiple doctors. Your dermatologist might not be talking to your endocrinologist. The assumption here is that you take most of your prescriptions to the same pharmacy. Except when your insurance makes you use a mail in pharmacy.

Comment by NoGifts Tuesday, Jan 24, 17 @ 11:22 am
wow…bigbrain lookin’ like he cares about somthin’ other than the anti worker stuff….must have polled and found he had to have somethin’ other than the failed bid to trash madigan.
Not enough, but worth a try.
Wait til he finds out there are a zillion Rx stores in IL

Comment by Annonin' Tuesday, Jan 24, 17 @ 12:04 pm
yes, Norseman, efforts to merge.

but ultimately, a patient must participate in their care by informing doctors and pharmacists about things that are apart from what is in the computer/s. so note to everyone here, do you know that grapefruit juice can affect certain meds? That taking St. John’s Wort should be noted to your doctor? so much is vended OTC that can mix with meds. even food! share in conversations with your caregivers. they are not mind readers.

Comment by Amalia Tuesday, Jan 24, 17 @ 12:17 pm
This will be interesting to implement with drive-through windows.

Comment by Observation Tuesday, Jan 24, 17 @ 12:57 pm
Good to see the State at least looking at a solution. The present and growing problem is seniors who take multiple meds prescribed by multiple docs for multiple ailments and who are losing mental faculties.

Comment by Cook County Commoner Tuesday, Jan 24, 17 @ 1:06 pm
Other than requiring a sign to be displayed saying you are entitled to counseling, what does this rule really do? If they ask me if I want counseling and I say no, then they don’t have to counsel me. And given the fact that pharmacies usually have a long line, should the patient speak up if they have questions about the medication? And should some of the counseling be placed on the prescribing physician?

Last time I went to the doctor, she asked me what medications I was taking and if I had any allergic reactions. Then told me how she wanted me to take the prescription - 3x a day and with food. Then when I went to Walgreens, they asked me if I had any questions and I said no.

This rule appears to fix a problem, but does it really? And what about the sample medications that I picked up from the physician that my pharmacist might not know about?

Comment by Sigh Tuesday, Jan 24, 17 @ 1:23 pm
Guessing this will jack up the E&O insurance on pharmacies and pharmacists. Trial lawyers are in heaven… someone else to drag into court to make them prove they properly counseled a patient. Body cameras on pharmacists next?

Comment by Right Field Tuesday, Jan 24, 17 @ 3:41 pm
@Rich

=I still don’t understand why these big pharmacy chains don’t have computer programs that can automatically cross-check a customer’s prescriptions for potential harmful interactions. Why are we relying on human memory here? Humans can make mistakes because they get too busy (on orders from on high) or whatever.=

All pharmacies have exactly that type of system. Those systems actually require a pharmacist to override a warning of potential drug interactions before dispensing a drug or combination of drugs that can cause a bad reaction. The problem discovered by the Trib is that pharmacists were/are overriding the warnings without informing the patient and/or the prescriber.

Those systems, however, identify all POTENTIAL drug interactions, some of which may not apply to the particular patient. Pharmacist often override those warning knowing that what is being warned about is not a problem in the particular circumstance. The warnings are apparently so common that it becomes background noise to a certain extent.

Comment by Someone Who Knows Tuesday, Jan 24, 17 @ 4:17 pm
People do not always get all presriptions frm the same pharmacy. For instance if you are hospitalized they will not likely use your pharmacy. And they will depend on you telling them what you take.Besides one can get wrong presriptions and preparations from pharmicists and they do not agree. I as a layman have corrected pharmicists on esoteric issues that are not in the guidance they use. I have seen nurses after consulting with doctors correct wrong formulations for a particular medication. As someone who kNows says Doctors and puharmicists will make decisions about what may work without clear written guidance as to the issue. It might be based on a single drug study or their experience. My experience with some challenging drug administration issues opened my eyes to how the pharmicists rely in large part on drug company and the info they provide for that formulation. Very few pharmacies are able to provide alternate formulations that are not on the label.

Comment by lost in the weeds Tuesday, Jan 24, 17 @ 7:46 pm
Also the patient does not always pick up the presription.

Comment by lost in the weeds Tuesday, Jan 24, 17 @ 7:50 pm
If your prescriptions or obtained via mail order will the pharmacist be required to contact you to offer consulting information?

Comment by campbell Tuesday, Jan 24, 17 @ 8:52 pm
There are several public drug interaction checking websites

http://reference.medscape.com/drug-interactionchecker

http://www.webmd.com/interaction-checker/

https://www.drugs.com/drug_interactions.html

http://www.rxlist.com/drug-interaction-checker.htm

http://healthtools.aarp.org/v2/aarp/dashboard#/drug-interactions

Given how much the country spends on drugs and internet technology its surprising that there isnt one standard public free website for this (I would have thought the drug industry in general and the FDA/ CDC/ HHS would have a big incentive to fund this)

Comment by Chicago1400 Tuesday, Jan 24, 17 @ 10:20 pm