World news wrapup: 8 October 2020

“Brutal cold bullying behaviours” of chain employers highlighted; APhA hopes to break Pharmacy Benefit Managers power; scope widens for some in NZ

UK: Large pharmacy chains are exhibiting “brutal cold bullying behaviours” in pressuring pharmacists to deliver large numbers of flu vaccines, says the Pharmacists’ Defence Association.

Some pharmacists have reported being expected to deliver 40 or more flu vaccines in a day as well as dispensing hundreds of scripts, “with no extra resources or sometimes even in the absence of regular dispensary staff”.

In releasing new guidance on providing vaccination, the PDA says that the increase in demand for flu vaccines was anticipated but employers did nothing to help them deal with the influx of work.

“The huge (and entirely predictable) increase in workload on these teams has meant that pharmacists are now working under extreme stress causing danger to their well-being,” the PDA says.

“In the absence of support from employers, pharmacists have been seeking from the PDA an exceptional level of support.

“Many are exhibiting a deterioration of their health, others are contemplating leaving the profession after decades of unblemished service. The PDA has received unprecedented levels of feedback from members on the impact to their well-being that this is having not only them but also on their wider families, especially when pharmacists are living with shielded or vulnerable persons.”


Arkansas, US: “Finally, the most critical grievances of our profession have been heard in the highest court of the land,” says the American Pharmacists’ Association’s executive vice president and CEO, Scott Knoer.

He wrote that the Justice of the Supreme Court of the United States has heard oral arguments in Rutledge v Pharmaceutical Care Management Association, a case which he says “may finally determine whether states can control the terrible business practices of PBMs”.

Pharmacy Benefit Managers are third-party entities which manage the prescription drug plans for payers including Americans with health insurance, insurers and large employers. Several states including Arkansas have been examining legal avenues for reining in their input.

“As you know very well, PBMs have been unaccountable to anyone since their inception, hiding behind a federal law that was never intended to shield the kind of harm that they’ve inflicted on pharmacies, pharmacists, and patients,” Mr Knoer wrote.

“We hope that today’s arguments will mark the start of a new era in pharmacy.”

He thanked stakeholders and in particular the Arkansas Pharmacists Associations and its leaders, as the case originated in that state, as well as the 45 state pharmacy associations which signed onto the amicus brief.

However, he notes that “the battle has only begun” and a decision from the Court is not expected until 2021, possibly as late as June.


Hailsham, England: A man has died and his family is considering legal action after a pharmacist gave him methadone instead of pethidine, reports the Daily Mail.

Nicholas Eaton was prescribed methadone as well as his regular medication to manage pain, an inquest heard.

Dr Hashem Soozandehfar, a pharmacist from Hailsham Medical Group had made an unintentional but fatal mistake when he dispensed the drug, the coroner said.

The mail reports that because of a medicines shortage, Mr Eaton was given 5mg of methadone instead of the normal 5mg of pethidine, and died only days after beginning the new drug. At post mortem he was found to have died due to a combination of COPD and methadone toxicity.

Dr Soozandehfar told the inquest that he thought the methadone was equal in strength to the pethidine.

A criminal investigation had been opened into the incident, but was dropped after police said that the pharmacist had not shown a lack of consideration to the patient’s life. Mr Eaton’s family is reportedly now considering civil action.

The coroner told Dr Soozandehfar that, “What you gave him was in fact 10 times the amount it should have been.

“It was a catastrophic error as is recognised by everybody in this room. But we can’t change history sadly. This error wasn’t made deliberately, it wasn’t made criminally.”

The inquest found that Mr Eaton had died from a medical prescription accident.


New Zealand: A change to prescribing rules which includes pharmacists will make it easier for New Zealanders to get the medicines they need, say New Zealand’s Ministry of Health and PHARMAC.

Previously, only medical practitioners, dieticians, nurse practitioners and optometrists were able to apply for special authority approvals. However, from 1 October 2020, pharmacist prescribers are now able to apply for special authority to prescribe specific restricted medicines.

Ministry of Health Chief Clinical Advisor Andi Shirtcliffe said that in some instances this means patients won’t need to wait for medical practitioners such as GPs or hospital doctors to sign off much-needed prescriptions.

“Pharmacist prescribers have specialised clinical knowledge about medicines, skills and understanding relevant to their area of prescribing practice,’ Ms Shirtcliffe says.

“They can provide individualised medicines management services, including prescribing medicines to patients.”

There are currently 36 practising pharmacist prescribers in New Zealand, who usually work in collaborative health team environments with other healthcare professionals such as general practice or hospitals.

To allow pharmacist prescribers to apply for a special authority, the Ministry updated the complex IT systems used to process special authorities, and PHARMAC updated the Pharmaceutical Schedule, effectively changing the rule.

PHARMAC Director of Operations Lisa Williams said the change was something both organisations had been working towards with urgency.

“This is a practical move to clear away red tape which was preventing the most efficient care for New Zealanders,” Ms Williams says.

“The application system and Schedule are now appropriate for the current health environment.”

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