BRISTOL MYERS AND OMNICARE DEVELOP A SCHEME To ILLEGALLY SOLICIT PERMISSION FROM TREATING PHYSICIANS FOR WHOLESALE SWITCHING TO MONOPRIL
Omnicare provides consultant pharmacists to educate physicians writing orders in
pharmacists, these consultants were required to put patient care above all other considerations.
When a patient in an Omnicare-serviced nursing home requires a prescription
medication, physicians give written or verbal prescription orders for their patients to nurses. The
nurses transmit the prescription orders verbally or by facsimile to Omnicare clerical data entry
personnel to be entered into Omnicare's computerized order entry system.
The verbal orders are also entered on "Physician Order Sheets," which should be
verified monthly by nursing home physicians as well as Omnicare consultant pharmacists in
order to make sure proper care is being given.
Once a prescription order is entered into Omnicare's order entry system, an
Omnicare pharmacist fills the prescription based on the physician's request. The medication is
then shipped to the nursing home facility where the patient resides. Once the prescription is
filled, Omnicare prepares a claim to be submitted to the government or private insurance payor
for reimbursement to Omnicare, the dispensing pharmacy.
It is illegal to switch a patient's medication within a therapeutic class without
express written permission from the treating physician. Therefore, Bristol Myers and Omnicare
facilitated the kickbacks-for-switches scheme through the illegal solicitation of what are referred
to in the trade as "Physician Authorization Letters" or "PALs." A PAL grants a pharmacist
blanket approval to switch a patient from one prescribed drug to another within a therapeutic
class. When PALs are solicited for legitimate and truthful reasons, their use is legal in some