Attention-driven choice: DEA vs. Omnicare, Inc

In the spring of 2012, the Drug Enforcement Administration (DEA) landed a major blow to the operations of Long Term Care (LTC) pharmacy through the $50 million settlement between Omnicare, Inc. and the Justice Department for claims of improperly dispensed controlled substances to patients in Skilled Nursing Facilities (SNF).[1]  Often in LTC, patients are discharged from hospitals with no written prescriptions for controlled substances to a nursing facility where prescribers are not on site.  It was common for pharmacies to dispense controlled substances on admission to ensure continuation of therapy until the SNF physician made rounds at the facility to continue or write new orders.  The Omnicare settlement was a shock to many pharmacists in LTC because until 2012 many of the processes within Omnicare were considered the standard of practice.

Bounded rationality explains how Omnicare pharmacists used the information at their disposal (years of practice and previous experience with Board of Pharmacy inspections) to determine that millions of controlled substance orders were valid, but new attention from the DEA on the written letter of the law (Controlled Substances Act) and treating a LTC pharmacy more as a retail practice than an institutional one shifted LTC pharmacy practice overnight.  Since 2012, LTC pharmacies have scrambled to update company Policies & Procedures to reflect the precedent set by the Omnicare case, resulting in increased operational costs and a decrease in medication availability in nursing facilities.

[1] United States Department of Justice. Omnicare to pay $50 million to resolve allegations of improper dispensing of controlled substances at nursing homes. May 11, 2012. Available at:, accessed February 26, 2014

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Joey Mattingly, PharmD, MBA is an assistant professor at the University of Maryland School of Pharmacy located in Baltimore, Maryland. Joey has managed retail and long-term care pharmacy operations in Kentucky, Illinois and Indiana. Leading Over The Counter is a blog of Joey's views and opinions on the topics of pharmacy leadership and management and do not represent the University of Maryland, Baltimore. Joey can be followed on Twitter @joeymattingly.

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