NPI Requirement for Prescriber ID Field (Posted 4/28/08 - 7/3/08)
Question:  After May 23, 2008, is an NPI required for the prescriber ID field on the NCPDP pharmacy transaction?   If the prescriber’s NPI is not available, or the prescriber doesn’t have an NPI, but the payer requires the prescriber ID, what alternatives, if any, are available for pharmacies to use to avoid having the transaction and the claim rejected?

CMS Response:  The prescriber identifier field on an NCPDP transaction is a provider identifier field and, as such, should carry an NPI in almost all cases when populated. It is expected that most prescribers will be covered entities and will therefore have an NPI assigned for use on all HIPAA transactions, where required. However, if the prescriber is not a covered entity, s/he may not be required to have an NPI, and may not opt to obtain one voluntarily. Thus, this provider would not have an NPI to include on the pharmacy transaction. If a health plan or other payer rejects a (pharmacy) claim because it does not have prescriber ID, and one is not available to the pharmacy, this presents a potential service disruption problem in point of service billing, which must be avoided when possible.

In the rare cases when either a prescriber does not have an NPI or the pharmacy cannot obtain an NPI, and where the prescriber ID is required by the payer, non-NPI individual identifiers may be substituted if allowed by the payer. In keeping with past practice, if no identifier is available a default identifier may be substituted; providers and pharmacies are encouraged to work with their payers for such default alternatives.

This guidance is expected to be used to cover exceptions. It is not intended to allow routine use of non-NPI identifiers or default identifiers in place of individual prescriber NPIs. Pharmacies are expected to make all reasonable efforts to obtain and utilize the appropriate individual NPIs for prescribers. Payers that elect to utilize the flexibility allowed under this Q&A should monitor pharmacy use of non-NPI and default identifiers to ensure that pharmacies comply with the requirement to use NPI whenever available. 
Source: Todd Stankewicz, CDR U.S. Public Health Service, Pharmacy Officer - CMS Region

Tamper Resistant Prescription Pad Update (Posted 3/27/08)
On April 1, prescriptions for Medicaid patients enrolled in traditional fee-for-service Medicaid must be written on tamper-resistant prescription forms.  The following is a brief summary of the requirements, excerpted from the American Pharmacists Association’s  (APHA) issue brief on the matter.  Click here to access the entire brief.

CMS Guidance to State Medicaid Agencies 

• Beginning April 1, 2008, the tamper-resistant prescription pad requirement applies to hand-written outpatient Medicaid prescriptions, including over-the counter medications in States that pay for them.

• The tamper-resistant requirement also applies to prescriptions printed in the prescribers office.

• Applies regardless of whether Medicaid is the primary or secondary payer of the prescription being filled.

• Section 1927(k)(3) of the Social Security Act provides exceptions for drugs that are not separately reimbursed and are provided in specified institutional settings. Such drugs in these settings (to the extent that they are not separately reimbursed) are exceptions to Section 1927(k)(2), and therefore, are not subject to the tamper-resistant prescription pad requirement.

• Section 1927(k)(3) of the Social Security Act includes the following, which are excluded from the tamper-resistant pad requirement:

§         Inpatient hospital services

§         Hospice services

§         Dental services (except when a State plan authorizes direct reimbursement to the dispensing dentist)

§         Physician services

§         Outpatient hospital services

§         Nursing facility services and intermediate care facility services for the mentally retarded

§         Other laboratory and x-ray services

§         Renal dialysis

§         In an institutional setting where the doctor or medical assistant writes the order into the medical record and then the order is given by medical staff directly to the pharmacy is considered “tamper-resistant,” so long as the patient never has the opportunity to handle that written order.

• Does not apply:
  • To refills of written prescriptions presented at a pharmacy before April 1, 2008
  • To electronic prescriptions
  • To prescriptions faxed to the pharmacy
  • To prescriptions called in by the prescriber
  • When a Medicaid managed care entity pays for the prescription
• Does not effect Drug Enforcement Administration (DEA) regulations regarding controlled substance medications that may require a written prescription.
• Does not restrict providing an emergency fill of any amount (up to the full prescription amount) of non-controlled or controlled dangerous substances for which a prescriber provides the pharmacy with a verbal, faxed, electronic, or compliant written prescription within 72 hours after the date on which the prescription was filled.
• CMS deems that the tamper-resistant prescription pad characteristics required by States’ laws and regulations meet or exceed the baseline standard (Indiana’s current regulations for controlled substance tamper resistant prescription forms is deemed acceptable.

Digitek (digoxin tablets) Recalled (Posted 4/28/08 - 7/3/08)
Actavis Totowa LLC notified healthcare professionals of a Class I nationwide recall of all strengths of Digitek, a drug used to treat heart failure and abnormal heart rhythms. The products are distributed by Mylan Pharmaceuticals Inc., under a “Bertek” label and by UDL Laboratories, Inc. under a “UDL” label. The product is being recalled due to the possibility that tablets with double the appropriate thickness may contain twice the approved level of active ingredient. The existence of double strength tablets poses a risk of digitalis toxicity in patents with renal failure. Digitalis toxicity can cause nausea, vomiting, dizziness, low blood pressure, cardiac instability and bradycardia. Several reports of illnesses and injuries have been reported. Patients should contact their healthcare professional with questions.  Source: FDA WedWatch, accessed online 4/28/08.

Board of Pharmacy Adopted Automation Rules (Posted 12/4/07-4/28/08)
On November 16, the Board of Pharmacy held a public hearing to receive comments on the establishment of standards applicable to all pharmacies and facilities that utilize and rely on automation technology to store, package, dispense, and distribute prescriptions or medication orders. The rules define "automated medication system". The rule will not affect those pharmacies and facilities utilizing automatic counting machines and unit dose dispensing equipment such as are typically found in small retail pharmacies.  The Board of Pharmacy adopted the Rule as proposed.  Click here to download the Proposed Rule. Look for more information, including a list of exempt technologies, in the December (No. 12) issue of the ImPAct newsletter.

FDA Issues Recall of Contaminated Syringes (Posted 1/28/08-4/28/08)
The U.S. Food and Drug Administration (FDA) announced on Friday (1/25/08) a nationwide recall of all lots of heparin and saline pre-filled flush syringes manufactured by AM2 PAT, Inc., of Angier, N.C. Two lots have been found to be contaminated with Serratia marcescens, a bacterium that can cause serious injury or death. These syringes are manufactured by AM2 PAT under the brand names Sierra Pre-filled, Inc. and B. Braun. They are sold in fill sizes of 3mL, 5mL and 10mL and syringe sizes of 6mL and 12mL. Consumers and health care facilities with any of the recalled, pre-filled Heparin Lock or Normal Saline IV Flush syringes should stop using the product immediately. Health care facilities should immediately quarantine the products in their inventory and return them to their distributor. Individual consumers should return them to the location from which they were received, such as a pharmacy or hospital. They should also let their health care providers know that they have been exposed to syringes recalled by FDA. The recall affects all lots of these products. The FDA received information that Heparin Lock Flush syringes from Lot 070926H and Normal Saline IV syringes from Lot 070917A have been found to be contaminated with Serratia marcescens, and have resulted in patient infections. The U.S. Centers for Disease Control and Prevention has confirmed growth of Serratia marcescens from unopened heparin syringes. Traditionally, Serratia marcescens, a bacterium found in water and soil has been linked to pneumonia, blood infections, and urinary tract and wound infections. Some patients exposed to the recalled syringes have developed blood infections.  The company voluntarily recalled these products on Jan. 18 after confirming bacterial contamination in some user samples.  Source: Food & Drug Administration (FDA) at  http://www.fda.gov/bbs/topics/NEWS/2008/NEW01785.html

Nonprescription Cough And Cold Medicine News Alert (Posted 1/17/08-4/28/08)
FDA informed consumers and healthcare professionals that the Agency has completed its review of information regarding the safety of over-the-counter (OTC) cough and cold medicines in children under 2 years of age and recommends that these drugs not be used to treat children in this age group because serious and potentially life-threatening side effects can occur. FDA's recommendation is based on both the review of the information the Agency received about serious side effects in children in the referenced age group and the discussion and recommendations made at the October 18 -19, 2007, public advisory committee meeting at which this issue was discussed. FDA has not completed its review of information about the safety of OTC cough and cold medicines in children 2 through 11 years of age. See the FDA Public Health Advisory for Agency recommendations regarding this issue.  

Read the FDA Public Health Advisory and a previous MedWatch alert dated January 12, 2007, regarding this issue http://www.fda.gov/medwatch/safety/2008/safety08.htm#cough

NCPDP Announces NPIs on HCIdea™ Database November 1, 2007 (Posted 11/2/07-4/28/08)
Phoenix, AZ – The National Council for Prescription Drug Programs (NCPDP), the pharmacy industry standards development organization, announced that the National Provider Identifier (NPI) is now available on the HCIdea™ database as of November 1^st, 2007. This database, with over 1.3 million prescribers, is designed by pharmacists specifically for the pharmacy services sector of the health care industry. All NPIs come from CMS, the “source of truth” for prescriber NPIs. NCPDP has married this data with other HCIdea prescriber information including DEAs, state license numbers, specialties, phones, and multiple practice locations.  The HCIdea™ online lookup tool (www.HCIdeaLookUp.org) allows pharmacies to obtain prescriber information using a web browser.  For a demo of this product please visit www.HCIdeaLookUp.org and click on “Watch the Demo.” Independent pharmacies wishing the product can subscribe online and obtain access immediately.

For large organizations, the HCIdea v2.0 relational database contains even more data. Optional prescriber sanction data is available. NCPDP also offers optional data enhancement services through its technical partner, Ingenix, Inc. These services range from simple NPI population of proprietary databases to full data compare and correction services.

For more information on HCIdea™ features and capabilities, contact NCPDP’s Robin Ebert at 480-477-1000, ext 118.

Board of Pharmacy Public Hearing on Automation Rules (Posted 11/12/07-12/4/07)
On November 16, the Board of Pharmacy will hold a public hearing to receive comments on the establishment of standards applicable to all pharmacies and facilities that utilize and rely on automation technology to store, package, dispense, and distribute prescriptions or medication orders. The proposed rules define "automated medication system". The rule will not affect those pharmacies and facilities utilizing automatic counting machines and unit dose dispensing equipment such as are typically found in small retail pharmacies.  Click here to download the Proposed Rule.

DEA Training Materials for Pseudoephedrine Restrictions (Posted ...-11/2/07)
The DEA just released training materials that pharmacies can use to train employees on the new restrictions related to the sale of ephedrine, pseudoephedrine, and phenylpropanolamine products.  As of September 30, 2006, retailers must train their employees on the new restrictions in order to continue selling these products.  The training materials consist of a short PowerPoint presentation. Retailers must use the DEA materials to train their employees.  However, retailers may supplement the training materials with additional materials of their own.  The DEA training materials are posted on their website at http://www.deadiversion.usdoj.gov/meth/index.html.

Pharmacists Needed for Mission Trip (Posted 4/30/07-11/2/07)
DePauw University’s Timmy Foundation chapter is looking for two pharmacists for our medical mission trip to Quito, Ecuador during October 13-21, 2007.  The trip consists of work in medical clinics, as well as many opportunities for sightseeing and cultural excursions.  The Timmy Foundation was founded in 1997 and strives to develop sustainable health projects in developing countries.  The foundation has been sending medical mission trips to Ecuador since 2001.  41% of the population in Ecuador lives below the poverty line and many of these people do not have any access to healthcare.  The goal of the trip is to provide basic healthcare to the people living in poor rural villages outside of Quito.  The cost of the trip will be around $1,350.  This price includes all expenses including air fare (air fare may be more or less depending on the city of departure).  The volunteer team will consist of physicians, dentists, pharmacists, nurses, and students.  This trip is an amazing experience and I encourage all that are interested to contact Jac Cooper at jacooper@depauw.edu or at 219-309-7944.  You may also want to take a look at Timmy’s website at http://www.timmyfoundation.org/home.htm   (The video on the homepage is from our trip last year.)  Those interested should reply before July 15.

Pharmacists Needed for Mission Trip (Posted 1/15/07-11/2/07)
Message from Dr. Emel Atkins: Missionary Health Service needs two pharmacists for our Sept. 15-29, 2007 health mission trip to Honduras.  All of our volunteers pay their own expenses and work in our “Whispering Hope Clinic” where we serve 15 needy villages.  (This area was chosen because they don’t have health care available.) We have an excellent hotel on the beach of the Caribbean Sea in Trujillo with a bus ride to the clinic each day.  We work a total of  7 clinic days and provide time for sightseeing and/or R & R at the end of the mission.  The Copan Ruins or the Bay Islands are favorites of past teams.Missionary Health Service (MHS) is a humanitarian Christian & charitable organization and volunteer’s expenses are all tax deductible.  As an interfaith organization, our focus is on health care and health education only.  MHS has been providing two mission trips a year since 1993.  To date our volunteers have come from 38 states and 3 provinces of Canada. 
The Participation Fee for the mission is approx. $1,000. depending on your preference of a single or double room.   This fee includes your hotel and meals plus bus travel in Honduras.  Air Fare is separate expense and varies depending on your city of departure.  Our volunteer teams consist of physicians, dentists, pharmacists, nurses, nurse practitioners, a med lab tech and special helpers.  Please contact Emel or Meg Atkins at 937-325-2646  or Gemkins@aol.com for questions or further information about this trip.  You can also visit our (not quite completed) web site at: www.missionaryhealthservice.org for more information of our mission work.

Clean Out Your Medicine Cabinet Day (Posted 2/21/07-4/10/07)
In celebration of National Poison Prevention Week, the Indiana Poison Center, the Marion
County Health Department (MCHD), the Indiana Pharmacists Alliance (IPA), and other organizations are hosting an event to encourage people get rid of unwanted medicine safely, instead of throwing it in the trash or flushing it down the drain. We need volunteer Pharmacists for 2- or 3-hour shifts. Pharmacists are needed to help identify medications. Volunteers will not handle medications, but they will need to help identify medications.  Controlled substances will NOT be accepted, and on-site security will be provided by MCHD.   For more information about the event, please visit click here.  To volunteer please send an email to tabitha@indianapharmacists.org with "Medicine Day" in the subject line of your email.  Please include your full name, contact information, and hours that you can volunteer.  For more information, click here.

CMS Proposed Rule: Comment Period Ends February 20 (Posted 2/18/07 - 4/10/07)
CMS has published a proposed rule that would be used by them to develop an Average Manufacturers Price (AMP) to set Medicaid reimbursement levels for generic drugs.  States would be required to use this formula when deciding what they will pay pharmacies for generic drugs.  The new formula would be set at 250% of AMP.  Because the prices that are charged to mail-order pharmacies and PBM rebates are included in the calculation, the amount that would be reimbursed would likely be less than the price which pharmacies can purchase the drugs for.  The comment period for the rules runs until February 20.  Please refer to the following sample documents that can be customized and sent to CMS.  We are urging all pharmacies to review the comments and send a copy to CMS.  The key point is to make sure that CMS hears from a large number of pharmacists and pharmacies.  Numbers are important!

Model Comments on AMP Rule for Pharmacies
2 Page Model Comments on AMP Rule for involved members

Directions for Filing Comments Electronically
The following are the links to be used to file electronic comments on the proposed AMP rules published by CMS.  Hint:  If you click on the link in Step 2 below, you will be taken directly to the online comment form.

1. Visit http://www.cms.hhs.gov/eRulemaking/ and choose Submit electronic comments on CMS regulations with an open comment period

2. Choose CMS-2238-P

3. Cut and paste from either of the two suggested comment letters (Model or 2 Page Model) into the comment form.
4.  

Pharmacy Education Foundation Innovative Grant (Posted 2/15/07 - 4/10/07)
The PEF will again award grants for pharmacy-related projects to be initiated this year.  The grants provide funds to help Indiana pharmacists in all practice settings explore new methods and services that enhance their role as pharmaceutical care providers, and to encourage them to share their experiences with others. For details, download the Innovative Grant guidelines and application.

DEA Publishes Interim Final Rule, Request for Comments
The DEA recently published an advance copy of an interim final rule with request for comment on "Retail Sales of Scheduled Listed Products; Self-Certification of Regulated Sellers of Scheduled Listed Products".  This regulation will implement the new requirements for products containing ephedrine, pseudoephedrine, and PPA.  For more information, click here. ( - removed 2/21/07)

Take Action Now: TriCare Program (Posted __ - 11/30/06)
The Coalition for Community Pharmacy Action has been busy the last couple of weeks working on the National Defense Authorization Act.  We urge you to take action to inform Members of Congress of our concerns with the National Defense Authorization Act (H.R. 5122/S. 2766).  As you know, we are advocating that Federal Supply Schedule (FSS)  pricing be available to the Department of Defense (DOD) for prescriptions filled for military beneficiaries at retail pharmacies, just as occurs with those filled at military treatment facilities and the mail order program.  Attached are two background pieces for your information:
Background Document or  Retail Pharmacy Response to Congress. With the Federal Supply Schedule pricing available for retail prescriptions, DOD could achieve cost savings without mandatory mail or differential cost sharing to incentivize military beneficiaries to use mail. Even though consideration of these issues is currently limited to members of the Conference Committee, it is important we communicate with  the full House, and especially the leadership of both parties,  (Hastert IL, Boehner OH, Pryce OH, Blunt MO)  to talk to the Conferees and urge them to keep FSS pricing in the final conference report which will give military beneficiaries the choice as to where they have their prescriptions filled.To contact your  Representative please click the link http://www.capitolconnect.com/nacds/takeaction.asp 

A Call to Comment on USP General Chapter <1121> Nomenclature
Members are encouraged to comment on the newly published proposed revisions to Chapter <1121> Nomenclature, especially the section on the USP Salt Nomenclature Policy.  USP is seeking input from healthcare practitioners and other interested parties regarding the proposed text prior to publishing any revision of Chapter <1121> in a future edition of the USP-NF.  Under the policy, the title for a dosage form monograph uses the name of the molecule on which dosing and monitoring are based.  Members may view examples of the Salt Nomenclature Policy application by visiting http://www.usp.org/USPNF/pf/generalChapter1121.html

USP is now proposing to include the text of this policy in Chapter <1121> to broaden understanding of the policy among all parties who may be affected by it, including regulators, manufacturers, and practitioners. 
 

The Salt Nomenclature Policy is intended to:

• Standardize compendial monograph titles and definitions
• Achieve uniformity in expressing dosages
• Simplify prescription writing and pharmacy record-keeping
• Reduce the likelihood of medication errors by correlating the product name with the substance by which the product is dosed.

Because USP is particularly soliciting practitioner input on this proposed revision, we are offering the chapter online at: http://www.usp.org/USPNF/pf/generalChapter1121.html.  Please share this information with your colleagues and encourage their comment, as well. The proposed revisions also are published in the Pharmacopeial Forum (PF), Vol. 32, No. 4, July-August 2006.  Comments will be accepted through October 15, 2006, and may be submitted online at http://www.usp.org/USPNF/pf/1121comments.html, by e-mail to 1121comments@usp.org, or by mail to: USP Executive Secretariat, 12601 Twinbrook Parkway, Rockville, MD 20852, Re: <1121> Comments

Pharmacists Needed for Mission Trip (Posted __ - 6/26/06)
Message from Emel Atkins: Missionary Health Service needs two pharmacists for our Sept. 16-30th health mission trip to Honduras.  All of our volunteers pay their own expenses and work in our “Whispering Hope Clinic” where we serve 15 needy villages.  This area was chosen because they don’t have health care available.

We have an excellent hotel on the beach of the Caribbean Sea in Trujillo and ride a bus to the clinic each day.  We work a total of 7 clinic days and provide time for sightseeing and/or R & R at the end of the mission.  The Copan Ruins or the Bay Islands are favorites of past teams.

Missionary Health Service (MHS) is a humanitarian charitable organization and volunteer’s expenses are tax deductible.  As an interfaith organization, our focus is on health care and health education only.  MHS has been providing two mission trips a year since 1993.  To date our volunteers have come from 38 states and 3 provinces of Canada. 

The Participation Fee the mission is: $770 for a Double Room or $1035. for a Single Room.   This fee includes your hotel and meals plus bus travel in Honduras.  Air Fare is separate expense and varies depending on your city of departure.  Our volunteer teams consist of physicians, dentists, pharmacists, nurses, nurse practitioners, a med lab tech and special helpers.  Please contact Emel or Meg Atkins at 937-325-2646 or Gemkins@aol.com for questions or further information about this trip.

Pharmacists & Pharmacy Technicians Licenses Expire June 30 (Posted __ - 6/3/06)
Pharmacists and Pharmacy Technicians are reminded to renew their license before July 1.  The Indiana State Board of Pharmacy recently mailed a flyer to all pharmacists and pharmacy technicians with instructions to renew online or by mail.  Download the flyer for pharmacists and pharmacy technicians.  The Professional Licensing Agency (PLA) will again conduct a survey during the online renewal process.  Results of the 2004 survey are published in the Indiana Pharmacist (Vol. 87, No.1), which was mailed to IPA members in March.

Long-Term Care Pharmacies / Nursing Home Update (Posted 11/28/05 - 3/16/06)
Nursing homes without Internet access or who need Medicare prescription drug plan enrollment information for multiple residents can now do so via a special CMS fax-based procedure.  Read more about this update and download the required forms here.

Analysis of Pharmacy Dispensing Fees for Indiana Medicaid (Posted 11/11/05 - 3/16/06)
IPA recently obtained data from the dispensing fee survey that was conducted in 2004.  The Indiana Office of Medicaid Policy & Planning (OMPP) is required by IC 12-15-31.1 to conduct a survey of pharmacy providers every two years to assess the appropriate level of dispensing fees to be paid to providers for prescribed drugs. There were 1,232 pharmacy providers enrolled in the Medicaid program with claims between July 1, 2003 and June 30, 2004. Data from the survey of pharmacy providers was used to calculate the average dispensing costs.  Download the report here.

Governor Appoints IPA Board Member to a Committee (Posted 9/16/05 - 1/20/06)
On August 26, 2005, the Governor appointed Jeremy Thain, R.Ph., to serve on the Mental Health Quality Advisory Committee.  His term on the committee will expire on June 20, 2007.  Jeremy has been a member of the Indiana Pharmacists Alliance since 1986.  He currently serves on the IPA Board of Directors as IPA District 3 Representative.  The Mental Health Quality Advisory Committee advises the Office of Medicaid Policy & Planning (OMPP) and makes recommendations concerning implementation of IC 12-15-35.5-7(c) pertaining to Medicaid limitations and restrictions of mental health drugs.

Medicaid Reimbursement Update (Posted 9/2/05 - 1/20/06)
A proposed rule was published in the September 1, 2005 edition of the Indiana Register.  As published, the rule change would increase the discount taken by OMPP on brand name prescription drugs from 13.5% to 19%, and would change the way that insulin is reimbursed.  Currently insulin is reimbursed as an OTC drug, at 150% of the state’s MAC price.  The new reimbursement would be the same as brand name products, which would be AWP-19% and the applicable dispensing fee. We are urging all interested pharmacists to attend the scheduled hearing and to testify in opposition to the proposed cuts.  Testimony should focus on the outcomes for your particular pharmacy and how the proposed changes will affect it.  If you cannot attend in person, submit written comments to IPA.  The hearing for proposed rule change is set for September 22 at 9:00 a.m. in the Conference Center of the Indiana Government Center South, Room C.  Download the proposed Rule.    Written comments may be submitted to Marc Shirley, 405 W. Washington St., Room W382, P.O. Box 7083, Indianapolis IN 46207-7083.  Correspondence should be identified as referencing LSA Document #05-76.

Alliance Consultant Academy Name Change Approved (Posted 9/9/05 - 1/20/06)
The Board of Directors of the Alliance approved the change of the name of the consultant pharmacist academy at their meeting on August 10.  The proposal for changing the bylaws was published in the newsletter of the Alliance in June, and comments were solicited from the membership.  There were no comments received on the proposal.  Accordingly, the Board approved the change sought by the academies board of directors.  The name of the academy will now be the Indiana Academy of Long-Term Care Pharmacists (IALTCP).

APhA Launches Online Hurricane Katrina Resource Center   (Posted 9/2/05 - 1/20/06)
The American Pharmacists Association (APhA) recently launched the Hurricane Katrina Resource Center on their website.  The Resource Center includes Immunization Recommendations for Travelers to Affected Areas, A Message from a Pharmacist in Louisiana, Call for Volunteers, Disaster Supply Kit Checklist, Household's Medication Inventory for Patients, Alabama & Mississippi Medicaid Resources, and link to several related sites.  Visit the APhA Hurricane Katrina Resource Center today to learn how you can help.

Governor Appoints IPA Member to Board of Pharmacy (Posted 7/7/05 - 1/20/06)
On July 6, 2005, the Governor appointed William Cover, R.Ph., to serve on the Indiana State Board of Pharmacy. His four-year term on the board will expire on July 1, 2009.  Bill has been a member of the Indiana Pharmacists Alliance since 1995.  He served as a Member At-Large for the Indiana Academy of Community Pharmacists, and he currently serves as the President-Elect of the Community Academy.  The Indiana State Board of Pharmacy is responsible for setting professional standards for pharmacists and regulates the sale of drugs and devices in the state of Indiana.  For more information about the Board of Pharmacy, please visit http://www.in.gov/pla/bandc/isbp/.

State Board of Pharmacy Under New Agency, New Web Site (Posted 7/7/05 - 1/20/06)
Effective July 1, the Health Professions Bureau is under the Professional Licensing Agency (PLA).  Information related to the Indiana Board of Pharmacy can be found on their new website: http://www.in.gov/pla/bandc/isbp/.  License searches can be found under the "License Express" link.  The Board of Pharmacy mailing address also changed, although they will continue to get mail that is sent to the old address.  Visit their new web site for more information.

The November (No. 11) ImPAct Newsletter is Now Online (Posted 12/1/05 - 12/29/05)
Download the November ImPAct newsletter in Adobe Reader here.  Future newsletters will be available in the Members section of the IPA website for members only.  Members may download previous issues of the ImPAct newsletter in the Members section of the website, which is currently under construction.

Hurricane Katrina - Call for Volunteers, Pharmacists (Posted 9/6/05 - 11/10/05)
The Department of Health and Human Services (HHS) has established a Web site at www.hhs.gov/katrina and a toll-free number, (866) KAT-MEDI or (866) 528-6334, to help identify health care professionals and relief personnel to assist in Hurricane Katrina relief efforts.  Pharmacists are among the healthcare professionals needed for the relief efforts.  Visit www.hhs.gov/katrina/ and click on "Donate & Volunteer" for complete details and to submit your information online.

October is American Pharmacists Month (posted 9/23/05 - 11/10/05)
October is American Pharmacists Month, and the Indiana Pharmacists Alliance wants to make consumers aware of the importance of knowing their pharmacist and their medicine. The Governor also declared October 2005 as Indiana Pharmacists Month.  Please join us in celebrating INDIANA PHARMACISTS MONTH throughout October.  National Pharmacy Technician Day is Tuesday, October 25. 

Board of Pharmacy - Proposed Rules on E-Prescribing (Posted 8/30/05 - 9/9/05)
The Board of Pharmacy may adopt rules and procedures concerning the electronic transmission of prescriptions. Over the past few months the Board of Pharmacy's technology Rules Subcommittee has worked on proposed language.  Download the working draft of the new rules here. Send comments to ipalary@indianapharmacists.org or call (317) 634-4968 by September 7, 2005.  We will share the final version of the proposed rules when they are published in the Indiana Register.

Board of Pharmacy Proposes New Rule on Centralized Processing (Posted 7/21/05 - 9/9/05))
The Board of Pharmacy's subcommittee spent a good part of the year developing the new Rule, which requires the Indiana State Board of Pharmacy to promulgate rules on Centralized Processing.  The public comment period has begun with the Public Notice in the Indiana Register.  The Indiana Board of Pharmacy will hold a public hearing on the proposed new rule to establish the definitions, standards, and requirements for centralized processing services of prescription drug order.  The hearing will take place on August 8, 2005, at 9:30 a.m. at the Indiana Professional Licensing Agency, Indiana Government Center-South. Download a copy of the proposed Rule 37.  We are collecting comments to share with the Board of Pharmacy during the public hearing.  Please direct comments to IPA Executive Vice President Lary Sage.

Now Accepting Award Nominations (Posted 8/17/05 - 9/9/05)
The Indiana Pharmacists Alliance is accepting award nominations for the Annual Awards program.  The awards will be presented during the Annual Awards Luncheon on Saturday, October 29, 2005, during the IPA/CPI Annual Convention at French Lick Springs Resort.  Members are encouraged to submit nominations by Friday, September 9, 2005.   Awards include:

• Bowl of Hygeia (Awarded to a pharmacist for outstanding community service)

• Distinguished Young Pharmacist Award

• Innovative Pharmacy Practice Award

• Outstanding Student of the Year Award

• IACP – Joseph E. McSoley “Pharmacist of the Year”

• ISHP – Glen Sperandio “Hospital Pharmacist of the Year”

• IAPT – “Pharmacy Technician of the Year”

Sterile Compounding Rules Revised - Effective May 6th (Posted 4/27/05)
856 IAC 1-30-9 has been changed to include pharmacist interns, externs and pharmacy technicians. Along with pharmacists, they will now be allowed to compound sterile medications as long as they have documented training in the specialized functions of preparing and dispensing compounded, sterile pharmaceuticals, including the principles of aseptic technique and quality assurance. Also, included in this rule, the qualifying pharmacist needs to assure control of all products shipped from the pharmacy, be responsible for adherence to all current USP standards related to sterile compounding, and personnel cleansing and gowning. They shall also reject any such drugs, shipped or compounded, that were made in violation of USP standards.  856 IAC 1-30-8 has been changed to include an environmental control device that must be capable of maintaining at least an ISO Class 5 (Class 100) environment during normal activity. Examples of appropriate devices include: (A) Laminar airflow hood (B) Zonal laminar flow of high efficiency particulate air (HEPA) filtered air (C) Barrier Isolators. All of the changes to rule 30 will go into effect on May 6, 2005.  Click here to download a copy of the revised rules. 

Interdisciplinary GeroPsych/Behavioral Disorders Traineeship (Posted 7/12/05)

The American Society of Consultant Pharmacists (ASCP) announces GeroPsych/Behavioral Disorders Traineeship.  The deadline for receipt of applications for the 2005 session of the ASCP Foundation’s Interdisciplinary GeroPsych/Behavioral Disorders Traineeship is August 5.
The traineeship will be held October 24-28 at McLean Hospital in Belmont, Massachusetts. The Interdisciplinary GeroPsych/Behavioral Disorders Traineeship provides individualized, intensive, didactic and experiential  training for selected geriatric teams consisting of a pharmacist and a physician, physician assistant, or nurse practitioner.  It offers trainees the opportunity to observe and participate in the development of pharmacologic and nonpharmacologic treatment plans for persons suffering from psychiatric and behavioral disorders. Application materials are available at http://www.ascpfoundation.org/traineeships/train_interdisciplinary.htm.

FDA Updates Labeling for Viagra, Cialis and Levitra (Posted 7/8/05)
The Food and Drug Administration (FDA) today approved updated labeling for Cialis, Levitra and Viagra to reflect a small number of post-marketing reports of sudden vision loss, attributed to NAION (non arteritic ischemic optic neuropathy), a condition where blood flow is blocked to the optic nerve.  FDA advises patients to stop taking these medicines, and call a doctor or healthcare provider right away if they experience sudden or decreased vision loss in one or both eyes. Further, patients taking or considering taking these products should inform their health care professionals if they have ever had severe loss of vision, which might reflect a prior episode of NAION.  Read the entire press release for more information.

Write to CMS Today to Restore Residency Funding
The American Society of Health-System Pharmacists (ASHP) is outraged that the Centers for Medicare & Medicaid Services (CMS) has refused to restore funding for residency programs that provide vital post-graduate training for pharmacists in specialized areas of health care. Click here for ASHP's Press Release from April 25, 2005.  ASHP urges pharmacists and other interested persons to write CMS.  Click here for complete details.  Deadline to respond to CMS is June 24, 2005. (6/7/05-7/6/05)

The Indiana Pharmacists Alliance (IPA) is awaiting approval for the layout of the new log book that is required for sales of ephedrine and pseudoephedrine products (including liquid and gel forms) beginning July 1, 2005.  As soon as the log book is approved, we will notify members via the email listserv and fax broadcast.  An article summarizing the "Meth Bill" will appear in the Indiana Pharmacist (Vol. 86, No. 2) next week.  Members can log in to the Members Only site to read the article before it arrives in your mailbox next week.  (6/21/05-6/26/05)

Update on OMPP's Proposed Cut
Representatives from the IPA, CPI, and the Indiana Retail Council met with FSSA Secretary Mitch Roob on Wednesday, and Lieutenant Governor Becky Skillman and members of the Governor’s staff on Thursday to protest the recent proposal to cut the dispensing fee for Medicaid prescriptions from $4.90 to $2.00.  Both meetings were productive.  We believe that there are several things about the way Medicaid reimburses for prescriptions that weren’t well understood by some members of the new administration. They listened closely as we explained the reimbursement process and laid out our position on the proposal to cut the dispensing fee.  What’s the bottom line?  We don’t believe that there are any changes in the dispensing fee that are imminent.  We will continue to work with the OMPP on the pharmacy benefit, and to explore other ways to help the administration save program dollars without resorting to cutting the dispensing fee.  Both sides are committed to continuing the dialogue started yesterday.  We are optimistic that the end result of will be that the proposed cuts don’t occur.  (4/14/05-6/7/05) 

OMPP Proposal to Cut Dispensing Fee
Yesterday, the Office of Medicaid Policy and Planning (OMPP) presented an update on the 2006-2007 Medicaid budget forecast to the General Assembly.  Buried in the presentation was a single line item that said Decrease Dispensing Fee from $4.90 to $2.00! OMPP is projecting a savings in state dollars of $3.6 million in 2006 and $4.7 million in 2007 from this huge cut.  They intend to cut the dispensing fee from $4.90 to $2.00 for regular Medicaid.  The IPA will be meeting with FSSA Secretary Mitch Roob tomorrow morning in an effort to derail this proposal.  We’ll keep the membership up to date on the results of the meeting, and what to do to combat this proposal.  This is a shot aimed directly at the heart of community pharmacy throughout the state of Indiana, and we do not intend to take it while falling back.  We will publish more information as we obtain it.  Click here to view the document as an Adobe Reader (.pdf) file.  (4/12/05-6/7/05)

Medicare Part D Rules Released
The Center for Medicare & Medicaid Services (CMS) released the final rules on the new Medicare prescription drug benefit. The benefit begins January 2006 and allows all Medicare beneficiaries to sign up for drug coverage through a prescription drug plan or Medicare health plan. The rules cover over 1,600 pages.  Print a copy of the 12-page press release that summarizes the final rules. Click here to download the press release. Download APhA's Summary of Final Medicare Regulations - click here.   (  - 6/7/05)

ISHP Board Comments on Governor's Executive Order
On January 10, 2005, Governor Daniels signed an Executive Order that would require each hospital in Indiana to implement a medical error reporting systems (MERS). The Executive Order contained specific requirements of the reporting systems.  On January 19 the Indiana Society of Health-System Pharmacists (ISHP), an Academy of the Alliance, sent a letter to Governor Daniels  commending him on his dedication to improving the safety of healthcare for Indiana residents, and they offered several suggestions essential to an effective medication error reporting system.   Read Governor Daniels' Executive Order.  (  - 6/7/05)

IPA Responds to CMS Regarding Proposed Medicare Part D Regulations
The Indiana Pharmacists submitted a response to CMS regarding proposed Medicare Part D regulations.  For further details, click here.  (  - 6/7/05)

PTCB Announces Exam Locations for March 19th Exam
Examination locations for the March 19, 2005 PTCE have been posted. Admission tickets were mailed to the candidates on February 25, 2005. The ticket contains the exam location’s full address and a phone number to obtain directions. The admission ticket can also serve as a receipt for payment.  For exam locations and details, click here.

Consultant and Long Term Care Pharmacists CE
On February 15th the Indiana Academy of Long-Term Care Pharmacists (IALTCP), an Academy of the Indiana Pharmacists Alliance, will present an evening CE program, "Identification & Management of Anemia in the Elderly".  ( - 2/17/05)

Legislative Day - February 9, 2005
Don't miss the opportunity to hear about what’s current in the legislature.  IPA lobbyists will go over several bills that are of vital importance to the profession. Activities begin at 11:30 a.m. with a luncheon followed by a briefing from the Indiana Pharmacists Alliance and Community Pharmacies of Indiana leadership and our lobbyists regarding legislative initiatives for this session. For details, click here. ( - 2/11/05)

Young Pharmacists Attend Great Lakes Conference
In October, seven young Pharmacists attended the Great Lakes Young Pharmacists Leadership Conference (YPLC).  Read more about the conference and see group picture of attendees here. ( - 1/6/2005)

More Seniors Now Qualfiy for State’s Prescription Program
Indiana seniors can now earn more money and still qualify for prescription drug assistance through the Family and Social Services Administration’s (FSSA) Hoosier Rx program. For details, click here. (4-1-04 - 11/30/04)

Medicare Endorsed Discount Cards
Starting in June 2004, Medicare-approved drug discount cards will be available to Medicare beneficiaries for immediate savings on prescription drugs. Medicare will contract with private companies to offer new, voluntary drug discount cards.  Click here for complete details. (2-24-04 - 11/30/04)

IPA Presents...Women in Pharmacy: A Weekend of Leisure & Learning
Enjoy a weekend of leisure and learning with other women in pharmacy at the Embassy Suites Hotel in downtown Indianapolis and relax with a spa treatment at a local Spa. This weekend will include breakfast, lunch, spa service, optional gourmet dinner, and 6.5 hours of live CE. So mark the date and register right now!  For more details, click here.

Young Pharmacists Leadership Conference
The Indiana Pharmacists Alliance, in conjunction with the Ohio Pharmacists Association and the Michigan Pharmacists Association, is accepting applications for the Young Pharmacists Leadership Conference to be held in Maumee Bay State Park near Toledo, Ohio, on October 15-16, 2004.  Application deadline has been extended. Contact IPA for details.   Download the application: Click here (.pdf)  or Click here (.doc).

REMINDER: Nominations for Alliance Awards
The Indiana Pharmacists Alliance (IPA) is accepting nominations through July 1, 2004, for the following Annual Awards.  These Awards will be presented during the Annual meeting of the Alliance on October 9 - 10, 2004. (Removed 7.2.04)

• Bowl of Hygeia

• Distinguished Young Pharmacist Award

• Innovative Pharmacy Practice Award

• Outstanding Student of the Year

• Joseph E. McSoley Pharmacist of the Year

• Glen Sperandio Hospital Pharmacist of the Year

• Pharmacy Technician of the Year

IPA Officer Elections Now in Progress (6.2.04)
The Indiana Pharmacists Alliance (IPA) has begun elections for 2005 officers. Members will receive ballots within the next few days. Members of each academy will have the opportunity to vote for the IPA President Elect, their designated District Representative, and their Academy President Elect and Members At-Large.  Members of the technician academy will vote for their President Elect and Members At-Large.  A list of biographical information regarding each candidate is include in the mailing.  Or, click here to read about all of the candidates.  (Removed 6.24.04)

NAPLEX Exam Review (4.2.04)
The Pharmacy Board Exam is rapidly approaching, and the Indiana Pharmacists Alliance (IPA) wants to help you prepare.  The IPA is again offering a one-day program designed to help you review essential information from you pharmacy education and practical experience.  For more details, click here.  (Removed 6.2.04)

IPA Hosts PTCB Exam Review – June 10th (CANCELLED)
On June 10, 2004, the IPA will host another PTCB Exam review.  This review places an emphasis on pharmacy calculations and duties related to assisting the pharmacists in serving patients.  Cost is $95 and includes materials and lunch.  For more information click here.  Registration Deadline:  June 4th (limited to the first 25 registrants).  (Removed 6.2.04)

PTCB Application Deadline – May 21st
Technicians interested in sitting for the national Pharmacy Technician Certification Examination (PTCE) should apply for the Exam by Friday, May 21st for the July 17, 2004 test date. Candidates are encouraged to apply online at www.ptcb.org. (Removed 5.28.04)

Join Us For A Day At The Speedway on May 14th!
Our air-conditioned suite on Legends Row, looks out on famed Gasoline Alley and we will be able to see first hand the teams working on their cars in their garages throughout the day.  The package includes Track Entry Pass, Hospitality Pass to our suite, Food and Beverages all day, Gasoline Alley tour, and lots of action on the track. One of the former winning race cars will be honored, as well as other special events happening on the grounds throughout the day.  This is a great way for you to treat yourself, an associate, or even a client. For more information, download the brochure.  For more information, contact the IPA office at (317) 634-4968 or click here to register online by May 7th. After May 7th, please call the IPA office. (Removed 5.20.04)

New Number, Less Hassle for Pharmacists
The Centers for Medicare and Medicaid Services (CMS) released a new National Provider Identifier (NPI) regulation mandated by HIPAA on January 23, 2004.  The regulation requires health care providers covered by HIPAA (including pharmacists and pharmacies) to obtain a unique ID number.  For details, click here. (Removed 5.20.04)

PTCB Exam Locations for March 20, 2004 Exam
PTCB Exam Admission tickets were mailed to the candidates on February 27, 2004.  The ticket contains the exam location’s full address and a phone number to obtain directions.  For a listing of exam locations, click here.   New for 2004, examination candidates can now print an additional copy of their admission ticket at our web site www.ptcb.org.  The admission ticket also serves as a receipt for payment.  Also new for 2004, examination candidates will be able to find out if they have passed or failed the examination online at www.ptcb.org.  The availability of online examination pass/fail status will coincide with the distribution of the regular examination results via regular mail approximately 60 days after the examination. (Removed 3.19.04)

February ImPAct Newsletter Now Online
The February issue of ImPAct has been posted online.  Members can access the newsletter by logging in to the Members section of the IPA web page.  Highlights of the newsletter include:  NACDS Medicare-Endorsed Drug Discount Card, Senate Bills Passed, Testimony on Senate Bill, Box Warning for Viramune®,  INSTEP Hearing, Technician Cards Displayed in Pharmacy, TAKE THIS JOB & LOVE IT! (IPA Spring CE Meeting - March 20, 2004). (Removed 3.19.04)

Lilly to Offer Medicare Discount Card Available in June
Eli Lilly and Company announced yesterday that it will offer to participate in all government-endorsed Medicare prescription drug discount cards. In an effort to provide meaningful assistance to the most needy seniors, Lilly will seek to partner with government-approved programs to make the LillyAnswers program easily available to seniors with incomes below 200 percent of the federal poverty level and who do not currently have prescription drug coverage. For more details, click here. (Removed 3.19.04)

IPA Home Study CE - Page 3
The IPA recently mailed the first of two home study CE books for 2004.  During the printing process, page 3 of one article was replaced with a duplicate of page 2.  Please log in to the Members section of the web site to download a copy of page 3.  A copy will also be mailed to everyone who received the CE book last week. (Removed 3.19.04)

McSoley Scholarship Deadline Feb. 27
Each year, the Pharmacists Education Foundation (PEF) awards the McSoley Scholarship to a Pharmacy student at Butler University and Purdue University.  The McSoley Scholarship details can be downloaded on the IPA Students page. (Removed 3.1.04)

Indiana Pharmacy Technicians
Check out the latest numbers reported by the Health Professions Bureau.  Over 7,000 Pharmacy Technicians applied for state certification.  Nearly 6,000 received the state certification, over 1,000 received a pharmacy technician in training permit, and less than 500 applications are pending.  For updated information, visit the Technicians page on the IPA web site.  Current Pharmacy Technicians should apply with the state to obtain a Pharmacy Technician Certificate, issued by the State Board of Pharmacy.  All Pharmacy Technicians or Technicians "in training" must have a state-issued Certificate or in-training permit.  Visit the Health Professions Bureau at http://www.in.gov/hpb/ and click on the My Indiana License link to read the instructions and begin the application process.  For more information, please call the Board of Pharmacy at (317) 234-2067. (Removed 2.24.04)

Purdue University Offers Internet-Based Diabetes Self-Management CE Program
Interested in educating your patients to self-manage their diabetes? The goal of this educational opportunity for pharmacists is to provide the tools and training required to start up a diabetes care service in your practice. (Removed 2.24.04)

Indiana Academy of Long-Term Care Pharmacists (IALTCP) Hosts CE Program
IPA Consultant Academy, in conjunction with ISCP, will host a CE program on Thursday, January 29th.  Abbott Laboratories is sponsoring dinner and CE presentation at Eddie Merlot's, 3645 E. 96th St., Indianapolis, IN 46240.  Appetizers will begin at 6pm with the presentation an dinner to follow around 6:30pm.  The title of the CE program is "Epilepsy in the Older Adult" and Wes Matthieas, RPh, of Abbott Laboratories will facilitate the presentation.   This is the first of four education programs that will be presented over the course of this year.  Currently, programs are being planned for April in the Ft. Wayne area, July in the Indianapolis area, and October in the Lafayette area.  Keep an eye out for dates, time and place. Please RSVP by January 27th to Vicki Poole Hoffmann at Vic@HoffmannEngineering.com. (Removed 2.24.04)

ASHP Midyear Meeting Summary
Strategies for implementing computerized prescriber order entry systems, improving adherence to medication therapy, and preventing drug counterfeiting and diversion were just a few of the topics covered during the American Society of Health-System Pharmacists’ (ASHP’s) 38th Midyear Clinical Meeting in New Orleans, December 7-11, 2003.  More than 18,000 pharmacists, other health professionals, and pharmaceutical industry exhibitors were “jazzed up” by the myriad of educational, networking, and career advancement opportunities available at the largest annual international gathering of pharmacists. For more information, click here.  (Removed 2.24.04)

Medicare Prescription Drug Information Now
The Centers for Medicaid/Medicare Services (CMS) just released a web page with information on the Medicare Prescription Drug Discount Card and Transitional Assistance Program.  For more information, visit http://www.cms.gov/discountdrugs/  (Removed 2.24.04)

IPA Responds to Importation Issues
On behalf of the Indiana Pharmacists Alliance, Executive Vice President Lary Sage, submitted a Letter to the Editor of the Indianapolis Star regarding IPA's position on the prescription drug re-importation issue.  To read the Letter, please login to the Members section and click on Governmental Updates.  Interested parties may also read the article in the Indianapolis Star by searching for the article published on 9/25/03. (Removed 2.24.04)

January ImPAct Newsletter Now Online
The January issue of ImPAct has been posted online.  Members can access the newsletter by logging in to the Members section of the IPA web page.  Highlights of the newsletter include:  Call for IPA officer nominations, Spring Meeting, Medicare Drug Bill Update, EDS Awarded 3-Year Indiana Medicaid Contract, and Hoosier Rx Enrollment Update.  (Removed 2.15.04)

Medicare Prescription Benefit Signed by President
The December issue of ImPAct (IPA's monthly newsletter) summarized the Medicare prescription bill signed by President Bush on December 8, 2003.  Seniors will be able to choose from at least two different Medicare drug discount cards as early as June, and by 2006 comprehensive coverage begins.  To read more about this bill, log in to the Members site to  download your copy of the ImPAct newsletter. (Removed 1.28.04)

December Newsletter Now Online
The December issue of ImPAct has been posted online.  Members can access the newsletter by logging in to the Members section of the IPA web page.  Highlights of the newsletter include:  Medicare Bill Summary, 2004 IPA Calendar, Legislative Reminder, GSK Product Recall, Competitor Buys Iowa-based Medicap, Online Drug Ring Bust Charges 10 People in 3 States, Compounding Pharmacists Fight FDA on Veterinary Regulations, PTCB Re-certification Change, and New Member Update. (Removed 1.28.04)

Pharmacists Advocate for Medicare Patients
The Pharmacist Provider Coalition (PPC) unites seven national pharmacist organizations to advocate for improvements in the quality of care that Medicare patients receive from their medications. For more information, talking points, sample letters, and sample flyers, visit the PPC here.  (Removed 1.28.04)
 

Pharmacy Auction
Davies Auction will hold an auction this Saturday, December 13th.  They will auction items from IPA member Frank Fitch and wife Rosie Fitch, long time owners of Wynkoop Pharmacy in Delphi.  Items include antiques, pharmacy items, and  primitives.  For more information and directions to the auction in Delphi, IN, visit http://dcwi.com/~davies/upcoming.html. (Removed 12/15/03)

Notice of Intent to Adopt Patient Counseling Rules
The Indiana Board of Pharmacy intends to adopt a rule concerning patient counseling requirements.  Overview: This rule amends 856 IAC 1-31-1 concerning patient counseling.  Effective 30 days after filing with the secretary of state.  Public comments are invited and may be directed to the Indiana Board of Pharmacy, ATTENTION: Director, 402 West Washington Street, Room W066, Indianapolis, Indiana 46204 or by electronic mail to jbolin@hpb.state.in.us.  A public hearing on proposed amendments will take place on November 10, 2003, at 10:00 a.m. at the Indiana Government Center-South. Click here to view a copy of the notice published in the Indiana Register. (Removed 11/21/03)

Indiana Board of Pharmacy Proposes Fees for Pharmacy Technicians
The Indiana Board of Pharmacy proposes amendments to 856 IAC 1-27-1 Fees.  The proposed fees outline pharmacy technician initial application fee of $25 and biennial renewal of $25.  A public hearing on proposed amendments will take place on November 10, 2003, at 10:00 a.m. at the Indiana Government Center-South.  To read a copy of the proposed rules, as published in the Indiana Register, click here.  (Removed 11/21/03)