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<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>Dear colleagues,<o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>The Centers for Medicare and
Medicaid Services is issuing a proposed rulemaking under the healthcare act,
with comments due in 60 days. (It will come out in the Federal Register on
November 22<sup>nd</sup> but is available online now at the link below). The
proposal applies to Medicare Part D in long term care facilities. It includes
both a proposal to limit the dispensing of most branded drugs to 7-day
quantities at a time (branded drugs are considered a first step) and a
requirement that Part D sponsors (the health plans) “include terms in their LTC
pharmacy contracts that require any unused drugs originally dispensed to the
Part D sponsor’s enrollees to be returned to the pharmacy…and reported to the
sponsor….Such contracts will also address contractual obligations for disposal
in accordance with Federal and State regulations…” This section is preceded
with the comment that, “Only when data has been systematically collected will
the extent of waste of Part D drugs be quantifiable on other than an anecdotal
basis.”<o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>The full document is here:<o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><a href="http://www.ofr.gov/OFRUpload/OFRData/2010-28774_PI.pdf">http://www.ofr.gov/OFRUpload/OFRData/2010-28774_PI.pdf</a><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>It’s also linked here: <a href="http://www.ofr.gov/inspection.aspx">http://www.ofr.gov/inspection.aspx</a><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>If you have other things to do
today, I suggest you scroll down to page 54 to see the language I’ve excerpted
above in context.<o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>PSI will be developing comments and
seeking input from our members and partners. If you are not already receiving
emails from me directly but are interested in being part of our discussions on
this topic, please contact me directly. I think this is an excellent
opportunity for state and local agencies concerned about reducing and managing
drug waste to weigh in. <o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'>Best regards,<br>
Sierra<o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif"'><o:p> </o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif"'></span></p></div></DIV>
<DIV><BR><BR></DIV>
<DIV STYLE="FONT-FAMILY: Courier New; FONT-SIZE: 9pt"><EM><FONT FACE="Arial" SIZE="2">The Department of Environmental Protection values your feedback as a customer. DEP Secretary Mimi Drew is committed to continuously assessing and improving the level and quality of services provided to you. Please take a few minutes to comment on the quality of service you received. Simply click on <A HREF="http://survey.dep.state.fl.us/?refemail=Laurie.Tenace@dep.state.fl.us" TARGET="_blank">this link to the DEP Customer Survey</A>. Thank you in advance for completing the survey.</FONT></EM></DIV>
<DIV STYLE="FONT-FAMILY: Courier New; FONT-SIZE: 9pt"><EM><FONT FACE="Arial" SIZE="2"></FONT></EM></DIV>
<DIV STYLE="FONT-FAMILY: Courier New; FONT-SIZE: 9pt"><div class=WordSection1><p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif"'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><b><i><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif";color:black'>Sierra E. Fletcher</span></i></b><span style='font-size:10.0pt;font-family:"Verdana","sans-serif";color:black'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif";color:black'>Director of Policy and Programs<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><i><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif";color:black'>Product Stewardship Institute,
Inc.<o:p></o:p></span></i></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif";color:black'>29 Stanhope St., 3rd Floor<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif";color:black'>Boston, MA 02116<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif";color:black'>617-236-4886 (phone)<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif";color:black'>sierra@productstewardship.us<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif"'><a href="http://www.productstewardship.us/">www.productstewardship.us</a><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif";color:#548DD4'><o:p> </o:p></span></b></p>
<p class=MsoNormal style='margin-left:.5in'><b><span style='color:gray'>Click
to follow us on </span><span style='color:#4F81BD'><a href="http://www.facebook.com/pages/Product-Stewardship-Institute/224328115936?ref=ts"><span style='color:#4F81BD'>Facebook</span></a></span><span style='color:gray'> and </span><span style='color:#4F81BD'><a href="http://twitter.com/productsteward"><span style='color:#4F81BD'>Twitter</span></a></span><span style='color:gray'><o:p></o:p></span></b></p>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:10.0pt;
font-family:"Verdana","sans-serif";color:#548DD4'><o:p> </o:p></span></b></p>
<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
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