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Published Study: Automated Mail-Order Dispensing Accuracy Sets Industry Standard for Pharmacy Dispensing Accuracy

Posted on: Tuesday, 8 November 2005, 09:01 CST

FRANKLIN LAKES, N.J., Nov. 8 /PRNewswire-FirstCall/ -- Echoing the call of legislators and healthcare visionaries to elevate the role technology plays in improving patient safety and reducing medication errors, a published study finds that a highly automated prescription dispensing system achieved dispensing accuracy rates 23 times better than those reported in a benchmark study of retail community pharmacies - resulting in a dramatic reduction in potentially serious drug-selection errors.

The findings appear in the November issue of Pharmacotherapy, the official peer-reviewed journal of the American College of Clinical Pharmacy, in the article "Dispensing Error Rate in a Highly Automated Mail-Service Pharmacy Practice." The study conducted by Medco Health Solutions, Inc. is the largest of its kind ever undertaken to examine the dispensing process, and was designed to parallel a 2003 Auburn University study on retail community pharmacy dispensing accuracy.

Compared to the Auburn study, which concluded that "dispensing errors are a problem on a national level" in the retail community pharmacy channel and observed a retail dispensing error rate of nearly one in every 55 (1.72%) prescriptions filled, the Medco study found in its mail-order operations an error rate of less than one in every 1,000 prescriptions (0.075%) - and zero errors in these critical areas:

-- Zero (0) errors in dispensing the correct drug -- Zero (0) errors in dispensing the correct dosage -- Zero (0) errors dispensing the correct dosage form (e.g., tablet vs. capsule)

"This study puts technology at the forefront of pharmacy practice, which is being shaped by the convergence of two distinct trends - more patients and more prescriptions," said Roger Anderson, a Medco senior vice president and chief pharmacist. "Preventable medication errors continue to plague our healthcare system, but through the use of quality controls and sophisticated automation we can achieve the highest level of dispensing accuracy for the patients who rely on us for their medications."

Details of Study Results

The Medco study, which was conducted over a seven-week period during September and October 2003, used a statistically valid sample of 21,252 prescriptions selected at randomly generated times from the final distribution point at Medco's mail-order pharmacies. The Medco study reported substantially fewer errors than the retail study - 16 total, or less than one error per 1,000 prescriptions filled (0.075%) with incomplete or incorrect label directions representing the most frequent error (14 of 16).

The 2003 Auburn study, published in the Journal of the American Pharmaceutical Association, involved registered pharmacists observing 4,481 prescriptions filled at 50 retail community pharmacies in six cities across the United States. In addition to reporting 77 errors - nearly one error per 55 prescriptions filled (1.72%) - the study also concluded that an estimated 51.5 million pharmacy errors occur annually based on the more than 3 billion prescriptions dispensed nationwide.

Similar to the Auburn retail community pharmacy study, the Medco mail- order study reviewed the accuracy of dispensed prescriptions based on factors such as correct drug dispensed, correct drug strength and correct dosage form. The Medco study also compared the dispensed medicines against the original prescription written by the doctor for both new and refill prescriptions - an additionally rigorous standard. The Auburn study could not for practical reasons reference the original prescription when evaluating the dispensing accuracy of refill prescriptions. The studies' findings also revealed some interesting comparisons including:

-- Errors in labeled directions were found 13 times more often in the retail pharmacy sample - 40 (0.89%) errors in directions at retail, compared to 14 (0.066%) for the Medco sample. -- Nine (0.2%) retail quantity errors compared to one (0.005%) for the Medco sample (the patient received an over-count of medication due to an order-entry error). -- The Auburn study reported eight errors in drug strength (0.18%), six errors in dispensing the wrong drug (0.13%) and one error in dispensing the wrong dosage form (0.022%); the Medco sample had zero errors in these important categories.

"Technology has helped revolutionize many sectors of the healthcare setting, improving quality of care and reducing costs to payors," said Anderson. "In an era where there is a safer, more efficient way to provide prescription healthcare, we should be doing everything in our power to encourage the use of this distribution channel. After all, one error is one too many - it's as simple as that."

To review the abstract and gain access to the full study visit http://www.pharmacotherapy.org/.

Mail-Order Myths

While the use of mail-order pharmacies to obtain maintenance (chronic) medications is on the rise, three persistent myths can still cause hesitation on the part of some patients - cost, less safety and convenience.

In August 2005, the Federal Trade Commission (FTC), following an exhaustive investigation of mail versus retail pricing, issued a report validating that mail-order pharmacies provide higher savings to pharmacy benefits payors and their members. The report found that for a common basket of drugs with same-size prescriptions, mail prices were typically lower than retail prices and that one of the reasons for these price differences is the PBM-plan sponsors' contracts often secured more favorable pharmaceutical pricing for mail dispensing than for retail dispensing.

Medco's study, reported in the November 2005 issue of Pharmacotherapy, proves that obtaining maintenance medications from its highly automated, large-scale mail-order pharmacies provides an accuracy rate that is 23 times that reported in a benchmark study of retail community pharmacies. In addition, obtaining a 90-day supply of medication (four refills annually vs. 12) through mail-order pharmacies and with the medication shipped directly to the patient's home mail-order features an added level of convenience. Pharmacists are also available around the clock, 365 days a year to assist patients with any medication question or to discuss adverse side-effects in the privacy of their home.

Medco, which operates the nation's largest mail-order pharmacy, filled 88 million prescriptions by mail during 2004. The company manages two of the most advanced mail-order pharmacies in the world, one at Willingboro, N.J. and the other in Las Vegas. Currently, approximately 95 percent of Medco's mail- order prescriptions were dispensed through those two facilities, which use a combination of robotics, scanners, information technology and licensed pharmacists to ensure accuracy. All nine of Medco's mail-order facilities are electronically networked. Mail-order pharmacy also saves its health plan sponsors up to 10 percent compared with drug store prices.

Drug Safety

Excessive pharmacist workload at retail pharmacies is one factor leading to a higher occurrence of prescription errors. A study from the University of California, San Diego, and published in the January 2005 issue of the journal Pharmacotherapy, concluded that fatal medication errors rose by as much as 25 percent at the start of each month due to beginning-of-the-month increases in purchases of medications, which result in heavier workloads for pharmacists.

The Institute of Medicine's groundbreaking 1999 report, To Err is Human, states medical errors account for at least 44,000 and up to 98,000 deaths annually, including adverse drug reactions. The Institute is also conducting a study of medication safety that Congress mandated under the Medicare Modernization Act of 2003.

Factors leading to medication errors include miscommunication between physicians, pharmacists and patients; confusing labeling and packaging; sound- alike names of medications; and environmental factors such as poor lighting, noise, interruptions and a significant workload, according to the Institute for Safe Medication Practices (ISMP).

About Medco

Medco Health Solutions, Inc. is a leader in managing prescription drug benefit programs that are designed to drive down the cost of pharmacy healthcare for private and public employers, health plans, labor unions and government agencies of all sizes. With its technologically advanced mail-order pharmacies and its award-winning Internet pharmacy, Medco has been recognized for setting new industry benchmarks for pharmacy dispensing quality. Medco serves the needs of patients with complex conditions requiring sophisticated treatment through its specialty pharmacy operation, which became the nation's largest with the 2005 acquisition of Accredo Health. Medco, the highest-ranked prescription drug benefit manager on Fortune magazine's list of "America's Most Admired Companies," is a Fortune 50 company with 2004 revenues of $35 billion. On the Net: http://www.medco.com/.

This press release contains "forward-looking statements" as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements involve risks and uncertainties that may cause results to differ materially from those set forth in the statements. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. We undertake no obligation to publicly update any forward- looking statement, whether as a result of new information, future events, or otherwise. Forward-looking statements in this presentation should be evaluated together with the risks and uncertainties that affect our business, particularly those mentioned in the Risk Factors section of the Company's Annual Report on Form 10-K filed with the Securities and Exchange Commission.

Medco Health Solutions, Inc.

CONTACT: Ann Smith of Medco Health Solutions, Inc., +1-201-269-5984, orann_smith@medco.com; or Janet Schiller or Bill Borden of Coyne PublicRelations, +1-973-316-1665, for Medco Health Solutions, Inc.

Web site: http://www.medco.com/http://www.pharmacotherapy.org/

Source: PRNewswire-FirstCall

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