The Virginia Society of Health-System Pharmacists fundamentally opposes any form of closed drug distribution system, i.e., a system of drug distribution and laboratory monitoring bypassing established mechanisms for drug use control and monitoring in organized health care settings (e.g., Clozaril Patient Monitoring System).

The major issues supporting this position include¹:

1. Compromising patient care: Due to the "bundling" of charges as it relates to drug procurement and monitoring, some health benefit plans will not cover drugs dispensed through such a mechanism. This means that patients who could benefit from the medication will not receive it. In addition, the monitoring of the patient's entire medication regimen and subsequent counseling activities, by a pharmacist, are bypassed.
2. Waste of health care resources: The duplication of effort mandated by closed distribution systems, whether it be in drug use control or laboratory monitoring, is inherently wasteful. At a time where the economics of health care carry such a priority, efforts should be made to simplify, rather that complicate medication dispensing and monitoring.
3. The precedent has been established for monitoring potentially toxic agents: Many drug products currently on the market have the potential for causing severe adverse effects.; However, to date the responsibility for monitoring the patient and the potential for such misadventures has been the responsibility of the prescribing physician and pharmacist, and should remain so.

It is the position of VSHP that when potentially hazardous medications are brought to market, it should be quite possible to devise an acceptable system that encompasses existing methods of drug prescribing, dispensing and patient monitoring.

1.Zellmer WA. An unsavory concoction [editorial]. Am J Hosp Pharm 1990; 47: 783.

Approved by Board of Directors: 2/1/91

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