July 17, 2002

Good morning. My name is Sharlea Leatherwood. I am a pharmacist and
small business owner in Kansas City, Missouri and am the chairman of the
NCPA Executive Committee. The National Community Pharmacists Association
is a 104-year-old organization representing the proprietary and
professional interests of independent pharmacies. There are more than
24,000 independent pharmacies in the United States, which dispense
nearly half of the nation's retail prescriptions.

NCPA would like to thank the Advisory Committee for the invitation to
provide background and feedback regarding the evaluation of written
information provided in community pharmacies. NCPA is pleased with the
study's report that nearly 90% of patients are receiving patient
information when they go to a community pharmacy---nearly five years
ahead of the benchmark established in 1996 at the Keystone Conference.
However, we share the Committee's eagerness to ensure the quality of
written information. I am on the panel that reviewed the usefulness of
the information collected in the survey. After evaluating dozens of
patient leaflets and, though, nearly all of them provided useful
information to the patient, I found variability in the topics that were
covered and the depth in which they were covered.

In describing the pipeline of information flow, I'll begin my
description going "upstream." With the filling of each prescription, a
patient drug monograph is generated (hold up example). In my pharmacy,
the monograph is attached to the patient's bag after receiving verbal
counseling from me or one of the pharmacists that work for me.

My pharmacy and nearly all independent pharmacies receive patient
information through their computer software vendor. Nearly all
independent pharmacies are computerized and lease or purchase software
support from one of numerous pharmacy dispensing system vendors in the
marketplace. My pharmacy receives updates twice a month from the
software vendor. These updates are usually done after store hours since
the updates are sometimes time consuming. The cost of these updates is
added to the software support charge from the computer vendor.

Changes to monographs or new drug monographs are added during these
updates. The pharmacy does not have the ability to alter the patient
monographs. In fact their agreement with the software vendor usually
forbids the modification of the information. The size of the patient
leaflet may vary because the limited space in the pharmacy department
limits the number of printers in the pharmacy. The same printer that is
generating two inch by two and three-quarters inch prescription labels
may also print computer monographs on the remainder of the page.

The kinds of printers used in pharmacies also vary widely. Some
pharmacies use laser printers while others may use dot matrix printers.
The type and availability of the printer and the dispensing software
that is used all influence the size of the patient monograph.

Continuing up the information pipeline, our understanding is that the
majority of software vendors supporting independent pharmacy computer
systems buy their information from First Data Bank or Medi Span. Our
understanding is that the computer vendors are also forbidden from
changing any of the information they purchase from First Data Bank,
Medi-Span, or other suppliers.

We understand that First Data Bank and Medi-Span receive their
information from primary sources, most prominently the pharmaceutical
manufacturer. Our understanding is that First Data Bank and Medi-Span
take the information given to them from the manufacturer's professional
package insert and incorporate it into the patient monograph information
sold to the computer vendors. That is our understanding, however,
representatives from these organizations can better describe the flow of
information into their companies and to the software vendors.

During the study period, there was only one provider of monograph
information with no other major competitor. There was only one source of
this information and this lack of competition may have negatively
impacted the quality of information delivered to the software vendors
and then to the pharmacies.

We have been giving written information on all prescriptions since 1988.
I use them as I counsel my patients about their therapy. We give the
monograph to the patient while they are waiting for the prescription to
be counted and labeled. I then point out various ways to avoid the
possible problems and what to do about them if they occur. My customers
have always appreciated this service. However, the marketplace has
driven my patients to other high volume settings and the quality service
that we provide has not been rewarded. However, it is only through the
verbal interchange that I detect possible probabilities of problems.
Some patients do respond that their doctor has told them everything but
as I continue to hit the highlights in the monograph, they realize that
there is more that they need to know. Some physicians have been upset
over the years about my interventions but the benefits certainly
outweigh the problems.

Undoubtedly, quality written information is essential in providing care
to patients. But I can't stress enough how the addition of oral
information from a pharmacist makes the written information come to life
for the patient. In many cases, the written information will prompt the
patient to ask me questions while I am counseling with them. Its not
uncommon for the patient to express relief that the side effects that
she read about is rare or unlikely. I am able to assure her and provide
guidance on what to do should a side effect occur. I mention this to
reinforce that no matter how much effort is placed into trying to
perfect written information, it only augments the pharmacist's verbal
information.

Thank you for inviting me to share this perspective from independent
community pharmacies and I would be happy to answer any questions that
you might have.