In one of the largest and most comprehensive investigations of its kind, the Chicago Tribune tested 255 pharmacies to see whether they would sell dangerous drug combinations without warning patients and found that 52 percent of pharmacies failed to mention potential interactions.
The study, which was two years in the making and published last month in the newspaper, reported that independent pharmacies had the highest failure rate, neglecting to warn consumers 72% of the time. Chain stores also had an alarming number of failures.
CVS was the worst of the chain stores. Of the 30 times the Tribune bought a potentially lethal pair of drugs, pharmacists failed to mention the risk 19 times. The 63 percent failure rate of CVS was followed by a 62 percent failure rate at Target — before its pharmacies were acquired by CVS — and a 60 percent failure rate at Kmart.
Walgreens, a main competitor of CVS, had the least amount of failures but still let investigators buy drugs without mentioning dangerous interactions 30 percent of the time.
“Anytime there’s a serious interaction, there’s no excuse for the pharmacist not warning the patient about that interaction,” Carmen Catizone, executive director of the National Association of Boards of Pharmacy, told the Chicago Tribune.
The paper enlisted the help of pharmacy professors to select five established drug pairs that could cause serious side effect, three of which have life-threatening risks. In one example in Evanston, Ill., a reporter attempted to buy the antibiotic clarithromycin and anti-cholesterol drug simvastatin at a CVS.
When taken separately, the drugs are relatively innocuous but can lead to kidney failure and death when taken together. The pharmacist filled the prescription for the reporter within minutes and failed to mention any danger.
The few pharmacists who did warn about the dangers were clear about the risks. “You’ll be on the floor. You can’t have the two together,” said one Walgreens pharmacist to a reporter.
Pharmacies Vow to Make Changes After Investigation
The paper reported that the issue was widespread. Failures happened in poor neighborhoods and affluent suburbs. Even one pharmacy at the Northwestern Memorial Hospital failed the test.
Several big chain pharmacies named in the investigation have vowed to make changes to address the lack of drug interaction warnings.
CVS, the largest pharmacy retailer in the United States with more than 9,600 stores, will be implementing changes this year “to dramatically increase the number of interventions our pharmacists will make with patients or their prescribers regarding potential drug interactions,” according to a statement issued to Drug Topics.
This includes policies to require pharmacists at the stores to call the doctor or warn a patient if a serious drug interaction is flagged by the computer system. Pharmacists will no longer be able to override the alert and fill the prescription until the consultation has occurred.
Walgreen is also “taking a number of proactive steps, such as looking at how we can accelerate current pharmacy improvement initiatives, and also reinforce the importance of patient consultations and interventions to consistently deliver the highest levels of patient care,” a spokesman for Walgreens said to Drug Topics.
Training for pharmacists and a review of computer alert systems will also be implemented at Wal-Mart and Kmart. The other pharmacies mentioned in the investigation, including Costco and Jewel-Osco, have yet to comment on any changes.
Investigation Draws Attention of Politicians
The investigation has drawn the attention of interest groups and politicians as well. Sen. Dick Durbin, the second-highest-ranking Democrat in the Senate, has reached out to industry groups like National Community Pharmacists Association to learn more about what they’re doing to reduce the risk of dangerous drug interactions.
“It’s hard for me to believe that, in this age of computers and software, we would still be dealing with such a fundamentally dangerous issue,” Durbin said in an interview with the Chicago Tribune.
Current laws pertaining to the subject are inconsistent throughout the states. Some states, such as Illinois, only require an “offer to counsel” patients on all prescriptions. That requirement is sometimes fulfilled by pharmacies with a general phrase, “Any questions?”
Durbin also wrote a letter to the Centers for Disease Control and Prevention to urge the federal agency to find out how common such failures are and look into how software can combat the issue.
Another group, the National Association of Boards of Pharmacy, told the Chicago Tribune it is willing to give Durbin advice on how best to develop national standards in new legislation.