Free generics from doctor's offices give N.C. Pharmacy Board heartburn

Doctors frequently give out free samples of brand name drugs without a special license, so why not generics? The kiosks also help maintain much better records than notes in the chart. However, the 30 day supplies bypass pharmacist review and may hinder efforts to improve quality through better computerized clinical review. Keep in mind that the costs associated with drug therapy problems may cost more than the drugs themselves.

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News & Observer, The (Raleigh, NC) (November 28, 2006)

Nov. 28--North Carolina's largest health insurer has gotten on the wrong side of state regulators.

The N.C. Board of Pharmacy has told Blue Cross and Blue Shield of North Carolina that it is concerned about the insurer's latest effort to get cheaper, generic drugs to patients: computerized kiosks that allow doctors to dispense free, 30-day samples.

Blue Cross has contracted with a San Diego company, MedVantx, to set up, stock and maintain the kiosks statewide. Six Triangle physicians already have them. But Blue Cross and MedVantx fell short of fully explaining the program to the pharmacy board, said Jay Campbell, executive director of the regulatory body. The board makes sure prescription drugs are dispensed without putting public health and safety at risk.

"There may not be any problem," Campbell said. "But finding out details [about the program] in the newspaper is not the way I like to do my job. I need to know what the heck they're doing."

A lawyer and pharmacist, Campbell advises the six-member board on legal issues and sets the board's agenda. He has asked Blue Cross and MedVantx to answer questions at the board's next meeting on Jan. 16.

Campbell said the board is concerned about regulatory oversight and the sample size being given to patients.

Can a 30-day supply be called a sample, Campbell asked. Prescription drug samples are usually for a three-day supply.

He also questioned whether program participants lack state licenses. North Carolina requires a license to dispense drugs. Pharmacists make sure that patients taking multiple medications aren't running the risk of dangerous drug interactions. Campbell said it's unclear who takes on that responsibility under the Blue Cross program.

Blue Cross and MedVantx representatives will provide regulators with the requested information at the January meeting, Blue Cross spokesman Lew Borman said. But Borman denied that the partners tried to sidestep regulators.

Borman said participating doctors are neither charged nor paid for using the kiosk. The free samples can be given to any patient, regardless of health insurance. Both Blue Cross and MedVantx argue that because physicians aren't compensated for the drugs, the physicians don't have to register for a dispensing license.

Blue Cross said it pays MedVantx a fee for each time a kiosk dispenses a sample. The insurer has declined to release the amount of the fee but says it will be less than the amount the insurer pays for brand-name drugs. Blue Cross projects savings of about $300 per sample.

When Blue Cross introduced the program last week, Borman said MedVantx had met with the pharmacy board before installing the first kiosk, and no concerns came up.

"That is not true," Campbell told board members in an e-mail message sent Nov. 22, the day The News & Observer reported Blue Cross and Blue Shield's plans.

Campbell remembered talking with a MedVantx representative. But "the rep did not explain the context of the question, much less describe the full scope of the program they were contemplating," Campbell's e-mail read.

Susan Hogue, MedVantx's director of account management, said she met with Campbell July 21 and presented information about the sampling program.

"We're really not trying to stimulate ill will," Hogue said. "Our goal is to work this out."