different medication within a particular therapeutic class, for any given patient the "preferred"
drug was often not the drug of choice from a medical standpoint.
Once a "switch" happened, the nursing home physicians, who make hundreds of
prescribing decisions daily, were unlikely to notice or comment on subsequent refill orders that
the prescription had been switched. Lisitza also has knowledge that often the nursing home
physicians, with responsibility for an incredibly high number of patients daily, would otten
continue to write the prescription for the medication he or she thought was appropriate, in spite
of the PAL. Omnicare ignored the physician's prescription and switched the drugs anyway,
without regard for whether the physician was writing the prescription for the original medication
knowing that the medication would be switched via the PAL or was, by his or her conduct,
indicating that the PAL switch was medically inappropriate for a particular patient.
The Omnicare computer system created a "hard block" whereby pharmacists
attempting to dispense the medication actually prescribed were precluded from doing so.
Omnicare pharmacists were supposed to ensure that a PAL was in place in order to switch to the
preferred medication. However, often there was no PAL in place, and Omnicare pharmacists
were pressured to switch the prescription with no physician authorization.
Not only was the switching scheme potentially threatening to a patient's health, it
sustaining drug therapies with the preferred medications can require a beneticiary to undergo
new tests to monitor the patient's response to the new drug therapy. The government (or, in the
case of privately funded patients, the private insurance payor), not Omnicare, bore the burden of
these additional collateral expenses.