`
`Letters
`
`Third-party Payer Reimbursement for Patient Education
`and Pharmacokinetic Dosing Services
`
`The Ohio State University Hospitals was being reimbursed
`by Blue Cross of Central Ohio for five‘patient-training pro—
`grams.I As of September 1. 1978. there are tth additional
`reimbursement programs: a steroid administration training
`prtfgram and a pharmacokinetic dosing service.
`Pharmacists. upon a written order hya physician. train pa-
`tients with adrenal insufficiency to administer steroids intra-
`muscularly, A total of [El patients have been instructed within
`'the last sitt 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:
`
`iteviewall relevant patient data.
`i.
`.
`2. Plan initial plasma sampling it required.
`ti. interpret and make remmmeridntiuns for drug doses based
`upon the plasma concentration.
`4. Assess the resultant serum drug: concentrations.
`_
`Fr. 'Prepare a written report.
`6. Prepare. a computer-generaled plot of drug concentration
`versus time,
`
`Blue Cross of Central Ohio will reimburse the hospitalfiflfl
`for each dosing consult tone per pal lent}. This charge is. rendered
`by the pharmacy and does not include any costs or fees associ-
`ated with the laboratory tests.
`The appr‘iwai for both programs resulted from meet lugs with '
`Blue Cross of Central Ohio officers. Myles l‘. Lash. Adminis-
`trator. University.r Hospitals. and me. Both programs will he
`required to demonstrate cost effectiveness using previously
`agreed upon standards of performance.
`1. Nolt‘l Eli and i’atimk US: 'i‘hird-party reimbursement for clinical
`pharmacy services; philosophy and practice. Am J Hos-p l’itornt
`«infill—6'26 (Aug! il-IT‘F.
`Edward G. Nold. 31.5.. Associate Director
`Department of f‘ltnrmm-y
`iftlitlt‘rst'fvt' Hospitals
`ill? W. Hill: Avenue
`('rtfumbus. ”H 4334’“
`
`Mannitol Crystallization in Plastic Containers
`Several months ago i had an unexpected experience while
`Using mannitol 259:. injection. 1 would like to bring this to the
`attention of hospital pharmacists as it poses a potential prob-
`lem.
`._
`'
`An order was received for mannitol '25 g to be given over :10
`minutes. This necessitated placing [lit] ml of mannitol 25% into
`an empty Vial'lex hag. Administration was delayed one hour. by
`which time a very heavy. white fiocculent precipitate appeared.
`l repeated the cvean using new material and found the pritip-
`irate formed in l2 minutes.
`'
`
`Using a fresh vial of mannilol l placed some into the Con:
`tinuliu tubing and had the same results. Placing another sample
`into a plastic 20-ml syringe again gave the precipitate.
`I am aware that maunitol commonly crystallizes when ex-
`posed to low temperature. This could out he the case in these
`instances since at no time was the mannitol exposed to tem-
`peratures below ”ii i". Furthermore. the liocculent precipitate
`observed in no way resembled the more common large crys-
`tals.
`[ realize that usually mannitol is given over a short period of
`time and this problem may heininimized. It is my intention to
`report this occurrence in cesethere is Some significance to it.
`
`Edward Emerson, Phat-tn. 1).
`Assistant Director of Pharmacy Affairs
`Woodland Memorial Hospital
`1325 ('rrt frlnll‘otrd Sirr't’t
`Woodland. ('ri H5695
`
`The observations reported by Dr. Epperson relative to crys-
`tallization of supersaturated solutions of mannitol when are
`temporaneously packaged in or allowed in contact plastic par-
`enteral containers. plastic administration tubing and plastic
`syringes are accurate.
`The aq ueous room temperature solubility of mannitul is in
`the neighborhood of 189t.wlv. Stipersaturated solutions of 20's.
`'and 2. ‘it'. wfv are commercially available. Such product's fre-
`quently contain the lung. needle-dike crystals typical ufrnannitul
`which has undergone Slow.
`relatively undisturbed crystal
`growth. In cases where such crystal growth has occurred, the
`mannitol may be resoluhilized hy 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 prod ucl. These surfaces may
`act as nuclei for crystallization to occur at a rapid rate. thereby
`providing alypically small crystals when supersaturated matt-
`nitol iniections are lliiliZt'tl. itesoltthilizalinn 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 he overcome by aqueous dilution of the super-
`saturated injection to 15*);- w/v or less prior‘ to contact with the
`plastic container or administration device. In all cases. however,
`it is our recommendation that a fiilrztlion device he used during
`_the administration of the liuid.
`_
`_ R. L. Nedich, Phil. Senior Manager. Plutrtnttccutit'nl Development
`’l‘rrtt-t'rinl erhurrrl'um-s. Im-
`f’i—Yfil Lincoln xit‘r‘iiltl'
`Morton {from H. Emil
`
`Salary Survey at Hospital Pharmacy Residency Programs
`The lihude island Hospital Department of Pharmacy ctmv
`ducted a salary survey of pharmacy residency programs in
`hospitals in March 1978. Questionnaires were mailed to each
`of the 89 training programs accredited by the American Society
`of Hospital Pharmacists at that time. Eighty-two (83'5“) ol'thc
`questionnaires were completed and returned. Similar surveys
`were Conducted in mat 19763 and 197?.“
`The salary range. based on an annual stipend. lor the li-
`month I'tonacadcrnic. nongovertunental programs (N = 48} was
`- $G.SDfi--$lfi.tili2. The. mean was $0,796 and the median $10.6'r'tl.
`The 1977 survey revealed a mean and median of $10.23] and
`$1 Ii,:i‘20. respectively.
`The salary range for nonacadentic. governmental programs
`(N = ii] was $lil.tttil)-$‘2ti.fifr:l with a mean of $35,640 and a
`median of $14.? 1 2. 'l'hcse programs are it! intuit he in duration.
`In analyzing the data from the programs surveyed which were
`offered by the various got-'erttmenlal services one mttst consider
`other criteria since in many instances financial remuneration
`
`Confirmed on page it'll“
`
`V0135 Nair 19m American Journal at Hospitat Pharmacy
`
`1337
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`PFIZER, INC. v. NOVO NORDISK AIS - IPR2020-01252, Ex. 1009, p. 1 of 1
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