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safety of the prescription drug system relies upon the honesty and proper motivation of drug

companies and pharmacists to benefit patients.

87.

When

Bristol Myers

and

Omnicare

cooked up

the

Monopril kickbacks-for-

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

88.

The American Medical Association ("AMA") has specifically condemned such

switching

practices

as

bad

medicine.

It

is

unethical

-

in

their

adopted

Policies,

the

AMA

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.")

89.

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

24

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