**IHS** **Pharmacy Program Update**

**June 8, 2004**

By CAPT Robert Pittman, <rpittman@hqe.ihs.gov>, (301) 443-1190

**Personnel Actions**

**[NAME]{.underline} [DATE]{.underline} [ACTION]{.underline}**

LT John Lester 07/01/2004 Transfer from Cherokee, NC (Resident) to Sr.
Pharmacist at Omak, WA

LT Carol Vondall 07/01/2004 Transfer from Staff Pharm. to Pharmacy
Resident at Albuquerque, NM

CAPT Joy Dearman 07/01/2004 Retiring from Claremore, OK

LT Amy Albertson 06/27/2004 Call to Active Duty as a Pharmacy Resident
at Claremore, OK

ENS Jodi Jones 06/01/2004 Call to Active Duty as a JRCOSTEP at Pawnee,
OK

LT Kathleen Raymond 06/01/2004 Interservice transfer to Sr. Pharmacist
position at Ketchikan, AK

CDR Robert Brady, Jr. 06/01/2004 Retired from Winnebago, NE

ENS Paula Carter 05/30/2004 Call to Active Duty as a JRCOSTEP to Ft.
Thompson, SD

ENS Melissa Ostroski 05/24/2004 Call to Active Duty as a JRCOSTEP to
Cloquet, MN

ENS Daniel Dangler 05/22/2004 Call to Active Duty as a JRCOSTEP to White
Earth, MN

ENS Steven Hall II 05/22/2004 Call to Active Duty as a JRCOSTEP to
Whiteriver, AZ

ENS Stephanie Arnold 05/20/2004 Call to Active Duty as a JRCOSTEP to
Phoenix, AZ

ENS Christie Burgers 05/19/2004 Call to Active Duty as a JRCOSTEP to
Cass Lake, MN

ENS Ben Jensen 05/17/2004 Call to Active Duty as a JRCOSTEP to Belcourt,
ND

ENS Carl Murray 05/17/2004 Call to Active Duty as a JRCOSTEP to
Claremore, OK

LT Rowdy Atkinson 05/17/2004 Call to Active Duty as a Staff Pharmacist
at Whiteriver, AZ

LT Brian Wren 05/17/2004 Change from Sr. Pharmacist II to Chief
Pharmacist at Tahlequah, OK

ENS Nathaniel Bossert 05/16/2004 Call to Active Duty as a JRCOSTEP at
Aberdeen Area Office

ENS Darla Klug 05/15/2004 Call to Active Duty as a JRCOSTEP at CSC
Phoenix, AZ

CDR Carmen Clelland 05/15/2004 Transfer from Winslow to Polacca, AZ as
Director Professional Service

LT Kaileen Skidgel 05/13/2004 Call to Active Duty as a Staff Pharmacist
at Pawnee, OK

ENS James Thurber 05/13/2004 Call to Active Duty as a JRCOSTEP at
Redlake, MN

ENS Julie Young 05/10/2004 Call to Active Duty as a JRCOSTEP at Lawton,
OK

LCDR Jamie Shaddon 05/10/2004 Call to Active Duty as a Staff Pharmacist
at Clinton, OK

ENS Katie Hagen 05/10/2004 Call to Active Duty as a JRCOSTEP at Sault
Ste Marie, MI

ENS Joseph Landers 05/10/2004 Call to Active Duty as a JRCOSTEP at
Wewoka, OK

LCDR Amy Rubin 05/10/2004 Change from Sr. Pharmacist to Assistant Chief
at Clinton, OK

LCDR Edith Murray 04/30/2004 Termination from Fort Defiance, AZ

CDR James Good 04/25/2004 Transfer from Harlem, MT to Immigration Health
in Tacoma, WA

CDR Annie Reiner 04/19/2004 Change from Assistant Chief to Chief
Pharmacist at Wagner, SD

LCDR Matthew Baker 04/19/2004 Change from Sr. Pharmacist to Sr.
Pharmacist II at Klamath Falls, OR

LT Jeffery Newman 04/16/2004 Transfer from Whiteriver, AZ to BOP
Springfield, as Sr. Pharmacist

LCDR Joseph Hubbard 04/03/2004 Transfer from Reno, Nv to Shiprock, NM as
Chief Pharmacist

LT Larron Dolence 04/01/2004 Change from Staff Pharmacist to Sr.
Pharmacist at Shiprock, NM

LT Clinton Krestel 04/01/2004 Change from Staff Pharmacist to Sr.
Pharmacist at Shiprock, NM

CAPT Steven Donelan 04/01/2004 Retired from Wagner, SD

LT Timothy Mehary 04/01/2004 Transfer from Tuba City, AZ to Sells, AZ as
a Senior Pharmacist

LT Wendy Mehary 04/01/2004 Transfer from Tuba City, AZ to Sells, AZ as a
Senior Pharmacist

LT Troy Bernardo 03/18/2004 Call to Duty as a Senior Pharmacist at
Gallup, NM

LT Hilcia Lambert-Bernardo 03/18/2004 Call to Duty as a Staff Pharmacist
at Fort Defiance, AZ

LCDR Judy Williams 03/10/2004 Inactivation from Seattle, WA

LT Ngozi Dike 03/01/2004 Call to Duty at San Carlos, AZ as a Staff
Pharmacist

LCDR Mark Feltner 03/01/2004 Change from Adv. Practice Pharm. I to
Assist. Chief at Whiteriver, AZ

CAPT Edgar Jeter 03/01/2004 Called to Active Duty from Retirement to
Phoenix, AZ

LT Randy Seyes 03/01/2004 Change from Staff Pharmacist to Senior
Pharmacist at Gallup, NM

CDR Barbara Sorrell 03/01/2004 Change from Assist. Chief Pharm. to Chief
Pharm. at Ft. Defiance, AZ

LCDR Dana Springer 03/01/2004 Change from Senior Pharmacist to Senior
Pharmacist II at Gallup, NM

LCDR Melissa Wentz 03/01/2004 Change from Sr Pharm. to Advanced Practice
Pharm. I at Ogema, MN

CDR Steve Wintersteen 03/01/2004 Retirement from Ketchikan, AK

**Credentialing and Certification**

***IHS Pharmacists Certified by the IHS NCPS***

The IHS National Clinical Pharmacy Specialist (NCSP) Credentialing
Committee certifies IHS and Tribal pharmacists in a variety of
specialties. For more information about becoming NCSP certified go to
<http://home.ihs.gov/MedicalPrgms/Pharmacy/News/credential/credmain.asp>.

The following pharmacists were credentialed in **ANTICOAGULATION** in
March 2004.

[NAME]{.underline} [LOCATION]{.underline} [NAME]{.underline}
[LOCATION]{.underline}

Gloria Arnold Cherokee, NC Louis Feldman Zuni, NM

Robin Bartlett Whiteriver, AZ Tom Horeis Zuni, NM

Johnny Benson Zuni, NM Cristen Smithmyer Cherokee, NC

Bradley Bishop Tahlequah, OK Maya Thompson Chinle, AZ

The following pharmacists were Re-certified in **ANTICOAGULATION** in
March 2004.

[NAME]{.underline} [LOCATION]{.underline} [NAME]{.underline}
[LOCATION]{.underline}

Clinton Bullock Talihina, OK Chris Lamer Cherokee, NC

Ross Green Talihina, OK Lisa Oliver Phoenix, AZ

Brian Johnston Talihina, OK

**Training**

***American Society of Health System Pharmacists***

The American Society of Health-System Pharmacists (ASHP) Annual Meeting
will be held on June 19-23, 2004 in Las Vegas, NV. To register for the
meeting or to make room reservations, go to the ASHP web site at
<http://www.ashp.org/> and click on "Summer Meeting".

***Pharmacy Practice Training Program (PTPP)***

Online registration is now available for the 2004 sessions of the IHS
Pharmacy Practice Training Program. This year the two sessions will be
in Phoenix, AZ. The first session is July 19-22 and the second session
is August 9-12. To register online, get more information, or download
the agenda, go to [[www.ihs.gov]{.underline}](../www.ihs.gov), select
Medical Programs, select Clinical Support Center, select Pharmacist
Training and follow on. This leads you to:
[[http://www.ihs.gov/MedicalPrograms/ClinicalSupportCenter/CSCPPTP.asp]{.underline}](http://www.ihs.gov/MedicalPrograms/ClinicalSupportCenter/CSCPPTP.asp).
The hotel for the venue is Four Points Barceló Hotel Phoenix
Metrocenter, 10220 North Metro Parkway East, Phoenix, AZ 85051, (602)
997-5900. For additional information, please contact Edward Stein at
(602) 364-7777.

***Academy of Managed Care Pharmacy***

The Academy of Managed Care Pharmacy (AMCP) 2004 Educational Conference
will be held on October 13-16, 2004, in Baltimore, MD. To register for
the meeting or to make room reservations, go to the AMCP web site at
<http://www.amcp.org/> and click on "Meetings".

**Dept. of Veterans Affairs Pharmaceutical Prime Vendor**

*The Department of Veterans Affairs (VA) currently allows Indian Health
Service (IHS) and Tribes operating health programs pursuant to contracts
under the Indian Self-Determination Education and Assistance Act
(ISDEAA), Pub. L. 93-638, use of the VA Pharmaceutical Prime Vendor
(PPV) for purchasing pharmaceuticals. By ordering through the VA PPV,
IHS and Tribes are able to access Federal Supply Schedule (FSS)
Contract, National Standardization Contract (NSC) and Blanket Purchase
Agreement (BPA) pricing for pharmaceuticals. IHS and Tribal
pharmaceutical purchases through the VA PPV totaled over \$185 million
in FY 2003. The VA PPV estimates that IHS and Tribes save approximately
50 percent annually off of the Average Manufacturer Price on
pharmaceutical costs by using FSS, NSC and BPA pricing.*

***New Eight-Year VA PPV Contract***

In early January 2004, the VA announced the award of a new 8-year, \$23
Billion Pharmaceutical Prime Vendor (PPV) Contract with McKesson
Pharmacy Systems (McKesson). McKesson's implementation plan for IHS and
Tribal sites is complete. Currently, all sites previously using
AmerisourceBergen should be able to order medications from McKesson.
Problems with ordering, delivery or billing should be reported to Wyman
Ford at the National Supply Service Center at (580) 436-5000, ext 122 or
<wyman.ford@mail.ihs.gov>.

***Direct Tribal Access to the VA PPV***

Tribes currently must use an IHS intermediary to access the VA PPV
contract. Tribes have asked for direct access to the VA PPV. IHS and the
VA have had ongoing discussions on this issue, and now that the new PVV
contract has been awarded, our discussions will resume. Currently, IHS
Office of General Council is working on a statement related to the
Economy Act that will allow IHS to be paid by VA for managing IHS
related contract issues, the IHS Pharmacy Program is working on changes
to the IHS and VA Interagency Agreement, and Tribal representatives are
gathering information regarding 1) which Tribes would be interested in
ordering directly from the VA PPV and 2) the total dollars those Tribes
spent on pharmaceuticals in FY 2003.

**Health Resources and Services Administration**

***340B Discount Drug Program***

Many Tribes are using the HRSA 340B Discount Drug Program to order some
or all of their medications. For information about the HRSA 340B
Discount Drug Program, go to the HRSA 340B web site at
<http://bphc.hrsa.gov/opa/> or call HRSA Office of Pharmacy Affairs at
(301) 594-4353.

**Centers for Medicare and Medicaid Services (CMS)**

***Medicare Drug Benefit - Drug Card***

The Medicare Prescription Drug, Improvement and Modernization Act of
2003 authorized a new Medicare Drug Benefit. The program started June 1,
2004, with a Drug Card Program and Transitional Assistance Program. IHS
and Tribes have worked closely with CMS staff and the two Indian Health
Special Endorsement Card sponsors ("Pharmacy Care Alliance," offered by
Express-Scripts; and "Criterion Advantage," offered by Computer Science
Corporation, also marketed under the name MemberHealth) to try to ensure
that American Indians and Alaska Natives will have access to these
benefits. The IHS and Tribes hope to access is the ability to bill card
sponsors for the \$600 per year credit in Transitional Assistance
funding available to low income card holders. IHS and the CMS Tribal
Technical Advisory Group (TTAG) are working with the sponsors to
finalize the pharmacy contracts and develop informational materials for
I/T/U staff and patients.

Medicare beneficiaries need not enroll right now.  They can enroll
later, or, if they enroll now in either of these general plans or some
other plan (using application materials available to the general
public), they can switch to one of the Indian Health specially endorsed
cards later.  A plan is not permitted to market to eligible Medicare
beneficiaries until CMS approves its marketing materials, however, both
of these cards are being marketed to the general public.  The addition
of Indian Health Service, Tribal and Tribal Organizations and Urban
program (I/T/U) pharmacies to their networks will expand options for
American Indians and Alaska Natives who use the drug cards.

Indian health beneficiaries who enroll in a plan will NOT lose their IHS
or Tribal pharmacy access.  Indian beneficiaries will be able to use
their drug discount cards at non-I/T/U pharmacies when they are away
from home or when their I/T/U pharmacy doesn't carry the specific drug
they need.  If the Indian beneficiary enrolled in a specially endorsed
plan is eligible for the \$600 Transitional Assistance Credit, and the
I/T/U pharmacy has a contract with the same plan, the I/T/U pharmacy may
collect for the prescription.

Look for additional updates over the next few weeks. Additional
information about the CMS Drug Card Program is available at
[www.cms.hhs.gov/discountdrugs](http://www.cms.hhs.gov/discountdrugs)
and [www.cms.hhs.gov/aian](http://www.cms.hhs.gov/aian).

***Medicare Drug Benefit -- Part D***

CMS is in the process of putting out a Federal Register notice about
Medicare Part D. Look for this to be published sometime in June 2004.

***Medicaid Reimbursement for Drugs purchased at Federal Supply Schedule
(FSS) Prices***

CMS is preparing a memorandum to State Medicaid Directors providing new
guidance on Medicaid payment for medications purchased at FSS prices.
IHS, CMS and VA will confer and agree on the content of the memorandum
before it is issued. CMS has agreed in principal that:

1.  IHS and Tribes can bill Medicaid for medications purchased at FSS
    pricing.

2.  Current billing practices should remain in place.

3\. Manufacturers must continue to provide FSS pricing, and state
Medicaid offices will continue to collect rebates from the manufacturers
for FSS medications billed by IHS. This process cannot be changed
without a legislative fix.

**Third Party Reimbursement for Medications**

***Point of Sale and Pharmacy Package***

Point of Sale (POS) is now in use at approximately 100 IHS and Tribal
sites. Pam Schweitzer is working with Express Scripts and Computer
Science Corporation (Patch 11) to ensure that sites will be able to bill
for Medicare Drug Card prescriptions. Patch 9, the most recent update to
the POS software, is complete. Patches 10 and 11 are in testing. Sites
should be sure they are up to date on previous patches and that they
have switched over to NCPDP 5.1 format (HIPAA compliant). As sites
prepare for the Electronic Health Record, they will need to make sure
their Drug File is up do date and that both outpatient and inpatient
pharmacy software is current (even at sites that do not have an
inpatient facility).

**Acquisitions of Medications**

***Importation of Medications from Canada***

Tribes continue to be approached by U.S. and Canadian companies
advertising that the companies can ship bulk medications to Tribes from
Canada at reduced prices. They also encourage Tribes to serve as
intermediaries for mail order prescriptions from Canadian pharmacies.
Tribes are advised that these activities violate the Federal Food, Drug
and Cosmetic Act. For additional information on this topic please go to
the IHS website at <http://www.ihs.gov/MedicalPrograms/PharmacyIssues/>
.

***National Core Formulary***

The National Core Formulary (NCF) was approved by the Director in
February 2004. Funding for the National Pharmacy and Therapeutics
Committee (NPTC) operations are being finalized. Look for an e-mail
requesting nominations for physician and pharmacist members of the NPTC
to come out in June 2004. The first NPTC meeting is expected during the
summer 2004.

***Indigent Drug Programs***

The Office of General Council is reviewing the IHS "Gifts
Administration" policy and additional ethical restrictions on acceptance
of gifts by federal facilities or programs to determine their impact on
accessing drug company bulk indigent drug programs.

**Recruitment**

***Pharmacist Recruitment Activities for FY 2003***

As of June 2, 2004, the Indian Health Service had 467 pharmacists (402
Commissioned Corps and 65 Civil Service) and 20 Junior Commissioned
Officer Student Training and Extern Program (COSTEP) students on duty
and reported 51 pharmacist vacancies. In the eight months of FY 2004,
IHS called to active duty 17 new pharmacists, two Senior COSTEP students
and 21 Junior COSTEP students.

***Loan Repayment Program (LRP)***

The IHS Loan Repayment Program has set aside \$2.33 million for
pharmacist loan repayment in FY 2004. This amount is expected to cover
approximately 33 new awards and 34 award extensions. The loan repayment
award cycle started in April 2004. Individuals who have applied for loan
repayment and who work at a site with a site score of 70 or above were
considered beginning with the April 2004 selections. Applicants at sites
with a LRP site score of 69 or below will not be considered for the LRP
until June 2004 selections. This policy change is to encourage
applicants to preferentially consider going to higher priority sites.
For information about the IHS LRP for pharmacists contact Janet Goodfox,
at (301) 443-3396, ext 4.

***Scholarship Program***

In FY 2004, the IHS Scholarship program anticipates 11 pharmacy
graduates. All 11 pharmacy graduating students have been contacted and
asked to consider applying for positions early in the spring of 2004.
Additionally, all 104 scholarship recipients (those with a service
obligation) have been sent information about the IHS Pharmacy Program
and opportunities to serve as a Junior COSTEP during the summer of 2004.

***Residency Programs***

The following individuals have been selected to residency positions in
2004-2005:

[Site]{.underline} [Resident]{.underline} [Pharmacy School]{.underline}

Anchorage, AK John Carothers Idaho State

Albuquerque, NM Carol Vondall University of Montana

Cherokee, NC Kyle Sheffer University of Utah

Chinle, AZ Anthony Steeno University of Wisconsin

Claremore, OK Amy Albertson Idaho State

Gallup, NM Larissa DeDea University of Florida

Gallup, NM Carrie Edsitty University of New Mexico

Phoenix, AZ Heather Huentelman University of Florida

Santa Fe, NM Laurelle Cascio Long Island University

Shiprock, NM Jennifer Essary University if Missouri

Tahlequah, OK Carla Guzic University of Maryland

Warm Springs, OR Katie Malone University of Kansas

Whiteriver, AZ Courtney Suggs Univ. of North Carolina

***National Recruitment Meetings***

The IHS will continue to recruit at colleges and universities throughout
FY 2004. IHS pharmacists also staff exhibit booths at national pharmacy
meetings. In December 2003, IHS pharmacists attended the four-day
American Society of Health-System Pharmacists Meeting in New Orleans,
Louisiana. In March 2004, IHS staff recruited pharmacists, pharmacy
students and potential pharmacy residents at the American Pharmacists
Association Annual Meeting in Seattle, Washington.

***MORE Project/Applicant Follow-up***

The Multi-Program On-line Recruiting Enterprise (MORE) system is up and
running on the IHS Pharmacy web site:
[www.pharmacy.ihs.gov](http://www.pharmacy.ihs.gov/). Pharmacists and
pharmacy students are able to enter contact information, ask questions,
and request that a recruiter contact them. The IHS Pharmacist
Recruitment Team (Team Ten) and others are currently using this system
to track pharmacist recruits. The MORE System currently tracks over 100
pharmacists with a graduation date of May or June 2004. The MORE system
is averaging three inquiries daily.

***Pharmacist Accession Bonus***

Commissioned Corps pharmacists who are newly hired by IHS or Tribes have
the opportunity to sign an Accession Bonus Contract within 60 days of
being called to active duty. For a four-year commitment, new pharmacists
receive a \$30,000, one time, lump sum payment. This has had a
substantial impact on pharmacist recruitment for IHS and the Tribes
(nearly doubling Commissioned Corps pharmacist hires in the last 2
years). The Commissioned Corps Pharmacist Accession Bonus is set to
expire September 30, 2004. The Public Health Service and Department of
Defense staffs have sent forward to the Surgeon General a report
documenting how the Accession Bonus has impacted federal pharmacist
recruitment. This report is expected to go to Congress soon.

New officers who are on a license limited tour will not receive the
Accession Bonus until they fax a copy of their pharmacist license to the
Division of Commissioned Personnel (DCP). The license should be faxed to
(301) 443-5366. Three to five days after faxing the license, officers
should contact Betsy Darracott at (301) 594-3352 to ensure that she has
requested a personnel order change for the officer.

***Recruitment Statistics***

  ----------------------- -----------------------------------------------
  PHS Commissioned Corps  
  Pharmacists on Active   
  Duty as of June 2, 2004 
  (includes short tours   
  and COSTEPs)            

                          

  **By OpDiv**            6/2/2004

  AHRQ (AHCPR)            1

  ATSDR                   1

  BOP                     137

  CDC                     6

  CMS (HCFA)              7

  DHS (est. 3/1/03)       20

  EPA                     1

  FDA                     237 (3)

  HRSA                    26

  IHS                     422 (20)

  NIH                     25 (1)

  OS                      16 (1)

  PSC                     4

  SAMHSA                  3

  USCG                    NA

  TOTAL                   906 (25)

                          

  ( ) JR COSTEPs on       
  Active Duty (included   
  in total)               
  ----------------------- -----------------------------------------------

**Computer Issues**

***Micromedex***

The IHS Office of Clinical and Preventive Service renewed the current
Micromedex contract through September 2004. IHS Office of Clinical and
Preventive Services has been working with the National Institutes of
Health to find additional funding for these databases. During summer
2004, IHS and Tribal sites will be informed how they can "buy-in" to the
Micromedex contract beginning in September 2004.

***Automated Prescription Refill Software***

The Pharmacy Auto Refill (BEX) software has been released and is
available from the Area Offices. The Pharmacy Auto Refill system allows
RPMS to interact with a commercial automated telephone system,
AudioCare®, to refill prescriptions. The system will also check on
prescription status and provide feedback to patients who are calling to
have prescriptions refilled. Sites who want to use the AudioCare®
automated refill call-in system will need to contact the company to
obtain a contract for the equipment. Account representatives are Alex
Seligson, (610) 296-9840 ext. 105, and Wendy Michaels, (610) 296-9840
ext. 170. Thanks to the everyone at Claremore, GIMC, Cherokee, and
Lawton for working so hard on testing the software!

***GPRA Indicators***

***MedMarx***

MedMarx is a medication error reporting system designed by USP.
Currently, 55 sites in five IHS areas use MedMarx for reporting their
medication errors. It is anticipated that over the next two years most
areas will be using MedMarx (or a similar system). The FY 2004
Medication Error GRPA indicator states that IHS will establish a
baseline for medication errors. The IHS Pharmacy Program has purchased
the MedMarx Multi-Facility Module that will allow for the tracking and
trending of medication errors at an Area and national level. Sites not
using MedMarx are asked to provide data for FY 2004. The following
information and format should be used:

Name of Facility:

Address:

Medication Error Coordinator:

Total medication errors divided by the following categories:

**Near Miss Errors**

Category A: Circumstances or events that have the capacity to cause
error.

Category B: An error occurred but the medication did not reach the
patient.

**Error Occurred but no present or future anticipated harm to the
patient**

Category C: An error occurred that reached the patient but did not cause
the patient harm.

Category D: An error occurred that resulted in the need for increased
patient monitoring, but no

patient harm.

> **Error Occurred with harm to the patient**

Category E: An error occurred that resulted in the need for treatment or
intervention and caused

temporary patient harm.

Category F: An error occurred that resulted in initial or prolonged
hospitalization and caused

temporary patient harm.

Category G: An error occurred that resulted in permanent patient harm.

Category H: An error occurred that resulted in a near-death event (e.g.,
anaphylaxis, cardiac arrest).

Category I: An error occurred that resulted in patient death.