HD12 - Study of Long-Term Care Pharmacy Operations Pursuant to HJR 642 of 1995


Executive Summary:
The Board of Pharmacy has not reviewed the specific issue of technicians checking unit dose carts. However, in response to other issues regarding technicians, the Board has requested the Board of Health Professions to study the need for licensing and regulating pharmacy technicians. The Board of Health Professions is expected to complete its study in the Spring of 1996.

An issue that arose during the course of this study relates to hospitals providing pharmaceutical services to residents in affiliated long-term care facilities. Hospitals purchase prescription drugs from manufacturers at deeply discounted prices. Some hospitals that own or are affiliated with long-term care facilities want to take greater advantage of these drug discounts by providing prescription services to residents of affiliated long-term care facilities. Current Board of Pharmacy regulations allow hospital pharmacies to provide services to facilities located "on the premises" of the hospital, but prohibit the hospital pharmacy from providing services to facilities off the premises. Community pharmacists, who do not receive the same manufacturers' discounts, believe that allowing hospitals to service long-term care facilities located off of their premises gives the hospital an unfair competitive advantage.

Federal antitrust laws directly affect this issue. There are differing views as to whether these federal antitrust laws, and recent court cases which interpret these laws, allow hospital pharmacies to provide these services to affiliated health care facilities. Resolution of this issue appears to require a thorough legal analysis which is beyond the scope of this particular study.

The study offers three policy options for consideration.

* Option I would maintain status quo.

* Option II would introduce legislation amending the Code of Virginia to allow pharmacy technicians to check unit dose carts prior to delivery to patients.

* Option III would request the Board of Pharmacy, in cooperation with the Office of the Attorney General to: (i) review current federal antitrust laws to determine their impact on the types of patients that can be serviced from hospital pharmacies; and (ii) re-evaluate current regulations governing hospital pharmacies in light of the legal review of federal antitrust laws.

Our review process on this topic included an initial staff briefing which you will find in the body of this report followed by a public comment period during which time interested parties forwarded written comments to us on the report. In many cases, the public comments, which are provided at the end of this report, provided additional insight into the various topics covered in this study.

/s/ Jane N. Kusiak
Executive Director