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12-25-2007, 11:15 PM
Patient safety may be compromised because of manufacturer relationships with specialty pharmacy companies, according to a discussion captured in the November 15 issue of the American Journal of Health-System Pharmacy (http://www.ajhp.org/cgi/content/full/64/22/2364) .

Health care payers are increasingly contracting with specialty pharmacies for high-cost injectable medications for patients. A manufacturer contracts with a specialty pharmacy company for exclusive distribution of a drug product, then the specialty pharmacies ship these medications to the homes of patients. The patients bring the medications to a hospital clinic or physician's office to be administered.

ASHP policy discourages hospitals and health systems from allowing injectable medications to be administered to patients when they are brought to a hospital or clinic by the patient or caregiver and the medications' storage conditions can't be verified. Instead, ASHP believes these injectable medications should be prepared for patients by the hospital pharmacy and obtained from a licensed, verified source.

During a roundtable of health-system pharmacy leaders held during the 2006 ASHP Midyear Clinical Meeting in Anaheim, participants discussed the pros, cons and other implications of specialty pharmacies, including the potential impact on patient safety.

Some of panelists argue that the injectable medications from specialty pharmacies can increase error rates and disrupt the patient's continuity of care. For example, medication reconciliation may be compromised because the injectable medication may not be included in the hospital's traditional record-keeping systems.

Roundtable participants also raised concern over the lack of reimbursement to hospitals that administer the injectable medications to patients. ASHP advocates that hospitals receive adequate reimbursement for preparation of the medication and other costs associated with the safe treatment of patients.

For more information on working with specialty pharmacies, see the ASHP's online Pharmaceutical Reimbursement Resource Center. (http://www.ashp.org/s_ashp/cat1c.asp?CID=490&DID=532)

American Society of Health-System Pharmacists (http://www.ashp.org/)