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C.

BRISTOL MYERS AND OMNICARE DEVELOP A SCHEME To ILLEGALLY SOLICIT PERMISSION FROM TREATING PHYSICIANS FOR WHOLESALE SWITCHING TO MONOPRIL

70.

Omnicare provides consultant pharmacists to educate physicians writing orders in

Omnicare-serviced

long-term

care

facilities

about

prescription

alternatives.

As

licensed

pharmacists, these consultants were required to put patient care above all other considerations.

71.

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.

72.

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.

73.

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.

74.

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

19

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