safety of the prescription drug system relies upon the honesty and proper motivation of drug
companies and pharmacists to benefit patients.
switches Market Share Agreement, Omnicare's Clinical Pharmacists, in conjunction with
advisors from Bristol Myers, were charged with developing the appropriate formula to equate the
dosage of the switched-to "preferred" medication with the dosage of the "switched from"
medication. This is not an exact science
The American Medical Association ("AMA") has specifically condemned such
opposes kickbacks-for-switches, denouncing the practice of pharmacists recommending
medication switches based on incentive payments before or after such switches. It is also unsafe
the AMA also disfavors switching therapeutic alternatives in patients with chronic disease
(such as hypertension, high cholesterol, etc.) who are stabilized on a drug therapy regime.
(AMA Policy H-125.9Il "Drug Formularies and Therapeutic Interchange.")
The AMA's concerns are not theoretical.
They affected thonsands of Omnicare-
serviced patients on a daily basis. Lisitza gained knowledge that Omnicare and Bristol Myers'
scheme sought to lull nursing home physicians into a false sense of confidence by Omnicare
pharmacists' constant reassurance that a "preferred drug of choice" would be as effective as the
medication a patient was initially prescribed within the same therapeutic class. Such equivalence
representations created two great risks.
First, as the AMA notes, switching a patient from one
medication to another when the patient is stabilized on the first medication, absent a clear
medical indication that a switch is warranted, puts patients at risk. Omnicare and Bristol Myers,
through their illegal PAL solicitation scheme, switched wholesale thousands of patients who had