letters

Saving the sample closet

Wow! Throw up a little difficulty and the anti-patient forces throw out the baby with the bath water (see "Closing the Sample Closet," Letters, November/December 2006, in response to "Taming the Sample Closet," October 2006). I find it amazing that physicians fear the influence of pharmaceutical reps and samples to the detriment of their patients. I realize that the availability of samples is not problem-free, most notably the amount of time it requires to maintain a sample closet (my staff does everything except dispense the medications), but I can't help but think that the reaction is self-flagellation for some ill-defined sin thrust on doctors by politically correct-ophiles. Doctors, won't you just step up and act like responsible adults?

James A. Taylor, DO
Jackson, Mich.

Flu vaccine distribution

The main reason physicians are still waiting for their flu vaccine was not addressed in the news story "Another flu season, another vaccine delay" [News & Trends, November/December 2006]. We believe we are unable to get the vaccine in a timely manner because most of the vaccines are shipped to private companies for distribution through pharmacy and grocery chains. These companies receive and administer the vaccine before our orders are even considered. While our patients get their flu shots at the local pharmacy or supermarket, we don't even have a ship date. When we finally get our order, many of our patients may already be vaccinated and then we are stuck with nonreturnable vaccine. It's not an availability issue; it's a distribution issue. The control and administration of flu vaccine should not be in the hands of the grocer or pharmacist. As physicians, we have the responsibility to diagnose and treat illness, so we should have the tools to prevent it at least as soon as chain stores do, if not before.

M. Birch, RN
David R. Birch, DO
Lewes, Del.

Pharmacists as nonphysician practitioners

We read "How to Bill for Services Performed by Nonphysician Practitioners" [May 2006] by Betsy Nicoletti with great interest. We would respectfully suggest the addition of pharmacists to her list of nonphysician practitioners. The services provided by pharmacists are eligible for incident-to reimbursement along with those of other nonphysician practitioners who work in compliance with the incident-to guidelines.

Pharmacists have a strong medication and disease management education, and a growing number also complete one or two years of postgraduate residency training. This education and training puts pharmacists in a unique position to enhance patient care in a family medicine practice. Pharmacists have long been established practitioners in academic outpatient clinics. A number of studies in the medical literature provide evidence demonstrating the clinical improvement that a pharmacist can bring to the primary care team.1,2

Interest in the use of pharmacists is growing. The Medicare Payment Advisory Commission recognized pharmacists as nonphysician practitioners and discussed reimbursement issues in depth in a June 2002 report to Congress.3 In the near future, Medicare Part D Medication Therapy Management Programs and new CPT codes for pharmacists' services (e.g., 0115T) will provide additional reimbursement opportunities that should facilitate collaboration between pharmacists and family physicians.

As the population ages and chronic care and medication choices become more complex, working closely with pharmacists becomes more useful to overburdened physicians. When changes in billing and reimbursement for pharmacists' services catch up with clinical practice, you will see more practices taking advantage of this beneficial collaboration.

Gary Noronha, MD
Jeanna Miller, PharmD
Jeffrey M. Brewer, PharmD, BCPS
Baltimore

1. Garrett DG, Bluml BM. Patient self-management program for diabetes: first-year clinical, humanistic, and economic outcomes. J Am Pharm Assoc. March/April 2005;45:130-137.

2. Lee JL, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA. 2006;296:2563-2571.

3. Medicare Payment Advisory Commission. Report to the Congress: Medicare Coverage of Nonphysician Practitioners. June 2002. Available at: http://www.medpac.gov/publications/congressional_reports/jun02_NonPhysCoverage.pdf. Accessed Dec. 11, 2006.