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NCPA Statement of Positions

Narrow Therapeutic Index Medications
NCPA supports the continued right of the pharmacist to utilize his or her professional judgment when deciding whether to substitute a chemically equivalent generic product for a brand-name pharmaceutical product in all therapeutic categories, including narrow therapeutic index medications. NCPA believes that payors, including government, should equitably compensate pharmacists for dispensing either brand or generic narrow therapeutic range medications so as not to penalize the pharmacist for making the appropriate clinical decisions on behalf of his or her patients.

Nationwide Prescriber Identification Number (PIN) System
Drug use review is an effective means to improve the health and safety of prescription drug consumers and is an effective means of health care cost containment. Effective drug use review requires the ability to identify the consumer, the pharmacist, and the prescriber. This data is also necessary to submit claims on behalf of consumers to third-party prescription programs. NCPA will work with organized medicine, health care insurers, health care claims processors, health care computer software suppliers, and governmental agencies to develop a nationwide prescriber identification numbering system that would be readily available to health care providers, regionalized for easy use, and acceptable to and recognized by all health care payers.

NDC Numbers
NCPA urges pharmaceutical manufacturers to display NDC numbers conspicuously in contrasting colors in no smaller than six-point boldface type on all prescription drug product labels.

New USP Environmental Standards
NCPA encourages the United States Pharmacopeia (USP) to adopt new recommendations for drug shipping, storage, and handling related to humidity and temperature control standards. The conformance to such USP recommendations is essential to maintaining the integrity and viability of environmentally sensitive pharmaceutical materials because it has been determined that the effectiveness of such materials is compromised by humidity and temperature excesses, thereby resulting in failure to control serious illnesses and, on occasion, death of affected patients:

NCPA further requests and encourages appropriate federal and state regulatory agencies to take appropriate action to adopt and enforce the new USP standards for drug shipping, storage, and handling. Such recommendations should be applied to all providers that share responsibility for the integrity of pharmaceutical materials that are determined and found to be compromised by environmental excesses including humidity and temperature.

Patient Access to Responsible Care
NCPA encourages and supports legislation that would ensure the right of patients to receive quality care in their "managed care" plan and, when necessary, to sue such plan or system that fails to provide quality care or limits patients? access to providers.

Patient Confidentiality
NCPA strenuously opposes electronic prescription transmission programs or manufacturers? marketing programs, such as patient information or poverty relief, that violate the integrity and confidentiality of the face-to-face relationship between the patient and the community pharmacist. NCPA supports explicit patient medical releases that prevent patient-specific data from being extracted, provided. or sold to extraneous parties without the informed and expressed written consent of the patient.

Patients' Bill of Rights
NCPA urges both the public and private sector to respect patients' rights with respect to health care providers, products, and pharmacy services by adopting the following Patients' Bill of Rights:

Rights Related to Choice of Provider:

The pharmacy patient has the right:
  • To seek a qualified and competent provider
  • To choose from among the wide variety of providers available in the marketplace
  • To receive definitive information regarding available services, so as to make an informed choice of provider

Rights Related to Choice of Product:

The pharmacy patient has the right:
  • To receive any legally prescribed product, realizing this may require the patient to bear the expense of such a choice
  • To ask for and receive any supplier's product that will legally fill a generically written prescription
  • To know the supplier of any product received
  • To have knowledge of alternative dosage forms available and to request an alternative from the physician

Rights Related to Pharmacy Services:

The pharmacy patient has the right:
  • To direct, one-to-one access to the pharmacist
  • To receive from the pharmacist information, instructions, and services regarding safety and cost-effectiveness of drug therapy. This includes the right to information pertinent to product selection when allowed
  • To expect the pharmacist to maintain a patient medication record to promote good drug therapy
  • To receive courteous service
  • To clearly posted information on services available and on hours of service, including information on after-hours emergency service and how to obtain it
  • To expect the pharmacist to be a public source of drug information
  • To receive continuity of pharmacy services, for example, in the course of discharge from an acute care or extended care facility to the community
  • To confidentiality in the handling of personal as well as drug and other health-related information

Patient Counseling
Because patient counseling by pharmacists contributes to quality patient care, NCPA supports mandatory counseling consistent with the professional judgment of the pharmacist.

A principal barrier to assuring the availability of pharmacist counseling has been the failure of private and public third parties to pay for such preventative services. The 1990 Medicaid Amendments required, effective 1993, counseling for willing Medicaid patients subject to the pharmacist's professional judgment. Nevertheless, the Health Care Financing Administration has not required or even encouraged payment to pharmacists for counseling Medicare patients. NCPA petitions HCFA to require payment for community pharmacist counseling under Medicaid.

Patient Package Inserts (PPIs)
NCPA supports a comprehensive patient drug education role for independent retail pharmacists. NCPA opposes, however, legislation or regulations that mandate patient package inserts for prescription drugs or that restrict or deny the appropriate exercise of the pharmacist's professional discretion in determining what drug information should be provided to patients.

P.D. Designation
The profession of pharmacy has reached a point where its practitioners should be using a uniform professional designation. The continued use of multiple designations serves only to confuse the public. NCPA supports the use of P.D. (Doctor of Pharmacy) by all pharmacists. The association also urges state pharmacy associations to endorse the P.D. designation.

Pharmacist Care
Medication without benefit of pharmacist care is no bargain. Pharmacists provide professional services to ensure that pharmaceuticals, a commodity, are taken properly and that the full benefit of drug therapy can be achieved. NCPA is committed to advancing the goals of pharmacist care, and to that end has created the National Institute for Pharmacist Care Outcomes. All independent pharmacists are strongly encouraged to provide pharmacist care for the benefit of their patients, and to take advantage of the certification programs offered by NIPCO, which is dedicated to achieving optimal patient health through pharmacist-directed disease management and wellness programs.

NCPA supports a testing process that includes demonstration of pharmacist care skills based on case studies, and that leads to pharmacist credentialing according to National Institute for Standards in Pharmacist Credentialing (NISPC) criteria.

NCPA supports federal and model state legislation that offers compensation to pharmacists for disease management. NCPA further supports federal legislation and encourages states to enact legislation to permit patients with health benefit plans to pay for products and services in addition to what their plan provides.



Copyright 1999: National Community Pharmacists Association. All Rights Reserved.