Comments on: Prescription For Profit

Meet The Whistleblower Who Exposed A Hospital's Dangerous, And Costly, Pill Swapping

[ldharlow]

Fighting..

No that''s not so....the therapeutic interchange would specifically state Pepcid 20mg is a substitute for Zantac 150...if someone did it differently. That''s a mistake on their part and if they don''t recognize the difference they should be in a different line of work

[ldharlow]

I don''t deny there are people that abuse the system(s) that is true of any...However, a blanket statement without all the details bothers me.

If the hospital bills more than the DRG the hospital EATS the difference....once again it pays to watch inventory and cost...just like in any other business.

Particularly since some drugs that are life saving and one of a kind get used infrequently but cost tens of thousands of dollars. We are always looking for something that is less expensive (as long as it works) to keep $ for things that are more $ which come out everyday...

[ldharlow]

Do No Harm absolutely applies to $$$.

Do No Harm is more than that, it means that we do everything we can to make sure you (pt) is better when they leave than when they arrived if at all possible, and people work VERY HARD for years in all phases of care to make that happen and it is not easy and many a desision is complicated by multiple factors not the least of which is money.

Hense my issue with how this was presented.

[brianbwb-2009]

"Well, no I''''d say my viewpoint was to take care of the people I am charged to look after." Posted by ldharlow

A noble statement and admirable sentiment indeed, but so far all of your justifications concern the hospital''s bottom line, not the patients''.

Also, if there is a difference between the price they charge the patient, and the DRG price they bill to an insurer, or Medicare, or whomever, who pays the difference?

Another observation I would make is that your position assumes an honest industry, be it hospital, insurance, drug company, even patients, but the vast majority of evidence shows that such is definitely not the case. Whenever the slightest opportunity for corruption appears, there are institutions and people more than willing to take advantage, no industry is even partially immune, this is the nature of unregulated capitalism, and human nature in general, our duty is to stop it whenever it occurs.

[fightingfro1]

Idharlow-

If the doctors prescribed 150 mg of Zantac, and patients were given Pepsid, They were probably taking 150 mg of pepsid. Obviously 20 mg of Pepsid shouldn''t cause the cited side-affects, but patients will likely take as much as the doctor said, being unaware of the substitution, or the significance of it.

[ldharlow]

"Prevledges" means that not just any joe blow can walk into your hospital and write you a prescription for care...not $. Every hospital has a standard of care that they spell out ...So Dr sonso doesn''t decide that Chicken blood is good for the cancer or something. In abiding by the code of conduct he or she understands that certain processes are in place and they can choose accordingly to practice or not to practice in the facility. They also have voting rights and the ear of the people on the P&T committee if they take issue with a substitution. (NOTHING IS IN STONE) things change and research is done all the time..and it is constantly reviewed.

[ldharlow]

as far as a substitution is concerned.

Let''s take the example given...Zantac vs Pepcid.

The article states that someone went into a coma because of the dose of Pepcid. 150mg Zantac and Pepcid 20mg are therapeutically intercangable..and There have NEVER been a reported case of someone going into a coma from 20mg of Pepcid...or any variation of that.....if someone went into a coma from the dose of the Medication...someone misprescribed it. In substitution there are direct corolations...not Massive differences.

Once again the if that happend the article is missing something...and that''s poor reporting

[ldharlow]

Well, no I''d say my viewpoint was to take care of the people I am charged to look after.

Just like a retail pharmacy that substitues a generic product if one is avail....it serves no purpose for a hospital to purchase a more expesive product if a less expensive one exists...unless it can be proven that the other is far and away superior therapeutically which does happen.

Now...it is possible that a Drug company that has patients on multiple drugs...like say a Merk has one that is THE ONLY OPTION in a class ($$$$$$) as well as one that has alternatives...($)...a hospital pharmacy may save $ across the board (they may have to have the $$$$$$ one for that set of patients) even thought one is more expensive..but % wise..there is a savings on a periodic basis.

Now something that was also not mentioned in the article is that reimbursement has changed in the 12 years since the suit began. Hospitals typically get paid based on what disease/ailment you have something called a DRG (Diagnotic Related Group)..not by the Price they charge...so it serves no one to charge more needlessly (more)

[brianbwb-2009]

"...but when physicians get hospital prevlidges, they typically sign off on P&T substitution initiatives. So it would come as a surpise to me if it were a surprise to him...unless his institution had no such thing which I believe is an industry standard." Posted by ldharlow

So you say that the doctors "privileges", which I take to mean benefits above the regular salary, are only given to doctors who sign on to what is essentially a "bait and switch" scam, and that this is "industry standard"?

[brianbwb-2009]

I would also ask, is the phrase "do no harm" limited to the end result of medical treatment only? It seems to me that economic harm can be just as bad as physical harm.

It also seems logical that if a "discount price" is even available, that the price is being set arbitrarily, not by market forces, or by any reasonable "manufacturing cost plus reasonable profit" formula, but by collusion of the drug manufacturers, in short the corruption is "supply sided", but apparently this idea has yet to be noticed by yourself, and many others.

[brianbwb-2009]

Sorry for the typo, I meant $650 million.

[brianbwb-2009]

I''''ll be happy to field any more questions.
Posted by ldharlow

I see that your viewpoint is from the prospective of how much the hospital saved, not how much more a patient had to pay unnecessarily.

I would also ask the percentage of incidents where a cheaper medication was available and prescribed, that the hospital filled the prescription without substituting the more expensive medication? Also, what is the percentage of cases where the hospital voluntarily substituted a cheaper medication, if available, with the thought of saving the patient money?

Also, if the hospital was "not at fault", who then was making the decision to substitute medications? It would seem that in the litigious zeitgeist of today, such decisions had to be approved by someone, and a record made of why the substitution was made.

For Merck to pay $650 as a settlement, indicates that this practice is quite common, as I am pretty sure they are not alone in this practice, only one of the "big fish" that got caught.

[ldharlow]

Add yet more:
It would not have been the "hospital''s task to get almost all the pt to take"...the hospital would have substituted one therapeutic agent for another which sounds like semantics but in reality....as far as they are concerned they used a product that in good faith made sense in their formulary...for reasons this article did not make us privy to. You will also notice that the article infers the hospital to be at fault but the hospital doesn''t seem to be mentioned in the lawsuit.

To be fair, the legal system found issue with the drug companies methods of marketing and I have seen questionable practices...that''s not my issue with this article.

It very much makes it sound like therapeutic interchange is dangerous..and it is not..not anymore than drugs are dangerous to begin with. To infer the people that work hard in your healthcare system to take care of others are out to gouge you is simply not so. Not to say there aren''t lapses in judgement from time to time..but in what industry (journalism for instance) hasn''t there been?...You believe everything you read or hear?

CBS needs to clarify the issue of Therapeutic Substitution vs. Market practice of Big Pharma...they are NOT REMOTELY the same issue.

[ldharlow]

Something else, the story states is that Dr LaCorte, "caught the hospital doing something strange", I don''t know the hospital in question, but when physicians get hospital prevlidges, they typically sign off on P&T substitution initiatives. So it would come as a surpise to me if it were a surprise to him...unless his institution had no such thing which I believe is an industry standard.

[irliberal]

Great story, GREAT doctor! Justice is served!!

[ldharlow]

I absolutely do work at a hospital with this practice.

Something is wrong with the data in the story... Brand Name Zantac costs $16.59 per 65 tablets = 0.25 per tablet....Brand Name Pepcid AC costs $7.66 per 30 tablets = .25 also!!!!!!!! So I take issue with the premise altogether.

I Stand by what I said.

Now if that hospital saved on more expesive drugs like Zocor when it was brand only cost more like $4-$5 per pill and was prescribed at least as much ....That''s how that hospital saved money...

I''ll be happy to field any more questions.

[brianbwb-2009]

"1)Ranitidine (Zantac) and Famotadine (Pepcid) are not "completely different" they are actually chemically very similar. The respecitive companies have patient rights because the molecular structures are slightly different. " Posted by ldharlow

One might think you were working either for the manufacturer, or the hospital that engages in the practice.

"Twice as much", as the article states, and "slightly more", as you state are very different. My own informal checks show that the article is closer to the truth, but still lowballed, as the price is often marked up even more.

It is also apparent that the prescription fillers were engaging in this practice without wondering whether the Zantac was prescribed precisely because of the "slightly different" chemical composition.

The companies settled because they knew what they were doing would expose them to much more expensive penalties in malpractice cases, which the evidence strongly suggests.

How much money is saved? None, if the cheaper drugs you describe were always substituted for more expensive drugs. If the drug companies are resorting to such practices, it is only to make more profit, and to heck with the patient.

[ldharlow]

Therapeutic substition saves BILLIONS of Dollars every year in WASTED out of date product. I''M shocked at the sesational nature of the story. I have been a Clinical Pharmacist in multiple institutions and have seen Thousands of patient charts and I have NEVER seen a single situation where substitution of a P&T approved product substition ever hurt a patient.

[ldharlow]

This story is a huge pile of garbage!! Further, I question the physicians and your stories informaiton. 1)Ranitidine (Zantac) and Famotadine (Pepcid) are not "completely different" they are actually chemically very similar. The respecitive companies have patient rights because the molecular structures are slightly different. 2) There is NO LITERATURE to demonstrate the any dose of Famotadine has EVER induced a coma...if there is I challange your reporter to produce it. 3) This product is not an "antacid" it''s an H2 blocker...your doctor should know the difference.
Your story fails to demonstrate that while the pepcid may have cost slightly more, that hospital may have saved money on other products by signing that contract. Your story further make it sound that the hospital in question was doing this to "make a buck". Hospital''s and Pharmacies cannot keep every one of the Thousands upon Thousands of drugs there are, if they did we''d all be broke, so drugs that have multiple alternatives are and need to be substituted for and Pharmacy and Therapeutic Committee''s at almost EVERY Hospital comprised of the best and brightest staff review the clinical literature (not the financial sheet) to decide what to and not to keep. If Katie went to her alma mater''s teaching hospital (UVa) Im sure they''d be happy to explain how the process works. Funny, we missed that side of the story.

[alphaa10-2009]

Once again, thanks to CBS for this series. The whole country knows frauds like hospital scams are almost commonplace, but we expect better of our fellow Americans-- especially hospital administrators andd drug companies. They are the very people who ask for our trust, and then violate it.

Courageous individuals who do the right thing-- some even at considerable risk to themselves-- make us proud to be Americans.