`
`Letters
`
`Third-party Payer Reimbursement for Patient Education
`and Pharmacokinetic Dosing Services
`
`The Ohio State Universityr Hospitals was being reimbursed
`by Blue Cross of Central Ohio for five'patient-training pro-
`grams.l As of September 1. 1978. there are torn additional
`reimbursement programs: a steroid administration training
`prrfgrarn and a pharmacokinetic dosing service.
`Pharmacists. upon a written order bya physician. train pa-
`tients I.vith adrenal insufficiency to administer steroids intra-
`muscularly. A total of 18 patients have been instructed within
`the last six months. Blue Cross of Central Ohio has approved
`a $25 charge for this training program.
`The pharmaCokinetic'dosing service provides for the phar-
`- macist to do the following;
`
`i. Iteview all releuint patient data.
`.2. Plan initial plasma sampling ifrequired
`ll. interpret and make recumrnendatiom for drug closes breed
`upon the pla~sma concentration.
`4. Assess the resultant serum druu‘ concentrations.
`Fr. Prepare a written report.
`6. Prepare. a c-omputer-gelteraler| plot of drug 'concentration
`versus time
`
`Blue Cross of Central Ohio will reimburse the hospital$20
`for each dosing consult [one per pal lent). This charge is rendered
`by the pharmacy and does not include any costs or fees associ—
`ated with the laboratory tests
`1he approval for both programs resulted from meetings with
`Blue Cross of Central Ohio officers. Myles l‘. Lash. Adminis-
`trator. University Hospitals. and me. Both programs will be
`required to demonstrate cost effectiveness using previously .
`agreed upon standards of performance.
`1. Nold lit: and Mabel: US: 'l‘hird-party reimbursement for clinicnl
`pharmacy services: philosophy and practice. rim of ”asp l’hnrm
`34:323—826 {Aug} iHT'i.
`Edward G. Nold. 33.8.. Associate Director
`Department of Pharmacy
`University Hospitak
`Hf! W. filth At'r‘rltrl'
`('ofurnhos, UH 433m
`
`Mannitol Crystallization in Plastic Containers
`
`Several months ago] had an unexpected experience while
`
`Using mannitol 2
`injection. 1 would like to bring this to the
`attention of hospital pharmacists as it poses a potential prob-
`lm‘
`.
`.
`An order was received for mannitol 2;": g to be. given over 3!)
`minutes. This necessitated placing ll‘if] ml of mannitol 25%. into
`an empty Viallex bag. Administration was delayed one hour. by
`which time a very horny white flocculent precipitate appeared
`I repeated the evean using new material and found the pricip-
`itate formedIn l2 minutes.
`
`Using a fresh vial ol mannitol l placed some into the Con:
`tinullo tubing and had the same results. Placing another sample
`into a plastic 20-ml syringe again gave the precipitate.
`I am aware that maonitol commonly crystallizes when ex-
`posed to low temperature. This could not he the case in these
`instances since at no time was the mannitol exposed to tem-
`peratures below if; F. Furthermore. the liocculcnt precipitate
`observed in no way resembled the more common large crys-
`tals.
`i realize that usually mannitol is. given ovcra short period of
`time and this problem may lie—minimized. It is my intention to '
`reportthis occurrence in casethere is Snme significance to it.
`
`Edward Epperson, Pharm. D.
`Assistant Director of Pharmacy Affairs
`Woodland Memorial Hospital
`l325 ('or trmtr’urrd Strr'r’i
`Woodland. CA 5156515
`
`The observations reported by Dr. Epperson relative to crys-
`tallization of supersaturated solutions of mannitnl when ex~
`temporaneously packaged in or allowed to contact plastic par-
`enteral containers. plastic administration tubing and plastic
`syringes are accurate.
`The aqueous room temperature solubility of mannitol is in
`the neighborhood of 18% w/v. Supersnturated solut ions of 202’
`and 2“u wfv are commercially available. Such products fre-
`quently containthe long. needle like crystals t.)pic-II ot mannitol
`which has undergone Slow.
`relatively undisturbed crystal
`growth. In cases where such crystal growth has occurred. the
`mannitol may be resolobilized by the aid of heat as described
`in the product‘s labeling. Recrystallization normally does not
`occur during-the time required for administration to the pa~
`'tient.
`'
`Plastic container or plastic administration device surface
`characteristics frequently differ from those of the glass container
`originally utilized to package the product. These surfaces may
`act as nuclei for crystallisation to occur at a rapid rate. thereby
`providing atypically small crystals when snpersat uratetl man-
`nitol injections are utilized. ltcsolubilizaliun of these crystals
`.with the aid of heat will not prove fruitful because the material
`may recrystallize within a short time period.
`Where solution volume intake is not a major concern. this
`problem may be overcome by aqueous dilution of the super-
`saturated injection to 15‘s. \w‘v or less priorto contact with the
`plastic container or administration device. III all cases. however,
`it is our recommendation that a filtration device he used during
`_the administration of the fluid.
`_
`_ R. L. Nedikh, Ph.D.. Senior lt-lonager. Pharmaceutical Development
`Tract-riot Laboratories. for.
`fi'ifli Lincoln .vlt'r‘rttu'
`Morton Grove, H. omit
`
`Salary Survey of Hospital Pharmacy Residency Programs
`The Rhode island Hospital Department of Pharmacy con-
`ducted a salary survey of pharmacy residency programs in
`hospitals in March 19%. Questionnaires were mailed to each
`of the 89 training programs accredited by the American Society
`of Hospital Pharmacists at that time. Eighty-two (88‘s) ofthe
`questionnaires were completed and returned. Similar surveys
`were Conducted in “HM 19763 and 1977.“
`The salary range. based on an annual stipend. tor the l2-
`month I'Ionrtcaclernic. nongovernmental programs (N = 43} was
`. “find-$15332. The. mean was $it].T.‘3fi and the median $10,6‘iti.
`The 19?? survey revealed a mean and median of $10.23] and
`$1 [1,320. respectively.
`The salary range for nonacadeniic. governmental programs
`(N = it] was $1:l.tittl)-$‘2t'l.fif12 with a mean of $15,640 and a
`median of $14512. 'l'hcse programs are 32 count hs in duration.
`In analyzing the data from the programs surveyed which were
`offered by the various governmental services one must consider
`other criteria since in many instances financial remuneration
`
`Confirmed on page [340
`
`votes NovtSi'e American Journal at Hospital Pharmacy
`
`1337
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`MYLAN INST. EXHIBIT 1009 PAGE 1
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`MYLAN INST. EXHIBIT 1009 PAGE 1
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