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been

stabilized

on

a

particular

medication.

Second,

because

of

the

umque

nature

of

each

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.

90.

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.

91.

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.

92.

Not only was the switching scheme potentially threatening to a patient's health, it

created

ancillary

expenses

increasing

health

care

costs.

For

example,

commencing

and

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.

25

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