Mr. Chairman and Members of the Subcommittee, on behalf of Murfreesboro Pharmaceutical Nursing Supply (MPNS) located in Murfreesboro, TN, and its 20 employees, I am pleased to submit the following statement for the record.

At the outset, I want to commend you and the Subcommittee for holding this important hearing.  As a Veteran, I truly believe that our collective effort to provide the brave men and women who fight on behalf of our country with the best quality healthcare is one of our most fundamental responsibilities.  Having been a proud participant in the contracting process that delivers medication to our Veteran’s, I am pleased to see the Subcommittee take a comprehensive view of the Department of Veteran’s Affairs (VA) contracting practices. 

As a matter of background, MPNS was founded in 1982 to provide pharmacies a user-friendly solution to regulatory changes in the long-term care industry. The solution MPNS brought to the table was providing long term care pharmacies FDA compliant and cGMP adhering repackaged unit dose medications in a universal format from a centralized closed door pharmacy.

In 2003, the VA, and in particular the Consolidated Mail Outpatient Pharmacy (CMOP) approached MPNS to provide recommendations and advice on more effective formats for the delivery of medication than traditional 120cc bottles.  The VA had grown concerned that this particular medication (for erectile dysfunction) was not being delivered in the most optimal nor cost effective manner.  We concurred!

Seems that this particular medication was only to be delivered in doses of 2, 4 or 6 pills and in a 120cc bottle.  In the course of delivery, it sounded as though there were 6 marbles in a bottle, making the medication a prime target for tampering or theft and re-sale.

MPNS recommended going with a solution of blister packs.  This delivery method would meet the standards of the CMOP in correcting their concerns and also save significant revenue for the VA that we would hope would be directed to other programs for our Veteran’s returning from combat.  For the past 7 years, the Mid-South CMOP has been the only one utilizing this automated method and MPNS has been providing the service with no complaint.

Mr. Chairman, the use of blister packs with pharmacies is a crucial delivery method that should be considered for all medications and with each CMOP.  I first recommended this method to the CMOP not for my own purposes, but because it is simply the safest and most economical format for the delivery of medication under any circumstance. 

The following are just a few of the key issues comparing blister pack delivery to bottle delivery:

A 120cc vial (bottle) costs the CMOP 60 - 65 cents per prescription due to the added cost of the bottle.  This is twice the amount of the blister pack.  The blister pack is priced based on a per tablet charge of 8 cents.  Delivery of the medication was based on packages of 2, 4 or 6 tablets per childproof vial.  Most deliveries averaged 4 tablets for an average cost of 32 cents per delivery.  At no time should a delivery in this scenario exceed 48 cents.  From our experience with ED medication and based on 1 million deliveries, using blister packs can save the VA around $300,000 annually.  There will be times when the delivery of medication will include medication that far exceeds our example, making the bottle delivery more cost effective.  However, for smaller deliveries, the CMOP should not give up it’s ability to provide medication on a per pill cost and utilize a more effective means of delivery of that medication.

In addition to the cost of the medication, you must consider the integrity of the medication.  In some cases the dosage can be diminished in the delivery process if it is chipped as a result of the medication rattling in a bottle.  This issue also addresses discretion related to the mailing of the product.  One of the participating factors in the Mid-South CMOP using blister packs had been an issue of discretion and concern over theft.

Finally, every year, millions of prescription bottles find their way into our landfills.  VA should be taking a responsible look at ways they can decrease their participation in this issue by finding more environmentally responsible formats of delivery such as blister packs. 

Mr. Chairman, our goal today is to inform you of this issue.  We respectfully request that the Subcommittee work with the VA to develop a plan for all upcoming procurements through the CMOP to utilize blister packs wherever possible.  Further, we believe that the VA should use its upcoming CMOP procurements to test automated blister pack delivery against automated bottle delivery methods between two willing CMOP’s to determine which method is more cost effective.

Thank you.