Tag Archives: pharmacies

The Battle Isn’t Over: What’s Next for the SafeRx Campaign

Knowing how to take prescription medications safely is incredibly important—especially for people who are limited English proficient (LEP) or have other difficulties understanding prescription medication labels.  New York recently passed landmark SafeRx legislation that will greatly increase many New Yorkers’ access to prescription medication. Under SafeRx, prescription pads will have to reflect a patient’s language preference and medication labels will become more patient-friendly. Pharmacies will be required to provide translation and interpretation services to LEP consumers. But while the passage of SafeRx represents a huge victory, we still have more work to do.

The law will go into full effect in late March of 2013. The New York State Board of Pharmacy (SBOP) is currently in the process of drafting recommendations for the implementation of the legislation. Unfortunately, the SBOP has failed to include stakeholders—advocates and LEP consumers—in the process. The SBOP has yet to schedule even one formal public hearing at which advocates and consumers can provide input on how to best implement the new law. Only one informal meeting has been mentioned, but not scheduled—and it’s in Buffalo. Not exactly an easy trip to make for many people around the state.

In response to the limited opportunities for stakeholder engagement, members of the SafeRx Coalition have published a report which discusses several key recommendations for the implementation of SafeRx legislation. (You can also read the accompanying cover letter to the SBOP here.) Through our recommendations, we hope to balance the interests of consumers and the pharmacy industry alike, while still meeting the health needs of New Yorkers.

Here’s a quick rundown of our recommendations:

Determine Pharmacy Primary Languages Fairly
Rather than selecting languages based on whether or not 1% of the general population speaks a given language, SBOP should require translation services in the top seven languages spoken throughout the state. This approach ensures that a uniform standard is applied statewide.

Standardize Prescription Labels
Prescription labels should be patient-centered. Labels should have clear directions, written in simple and large fonts.

Notify Patients of Their Rights
A Patient Bill of Rights should be translated into the selected languages and shared with consumers on pharmacy websites, in stores, and through other outreach.

Include Mail Order Pharmacies
Those count, too! Resources should be dedicated to assessing the language access needs of consumers who use mail order pharmacies and the services that these pharmacies currently provide. In fact, many mail order pharmacies actually have already begun providing language services.

Eliminate the Waiver Option
As the legislation stands now, pharmacies have the ability to opt-out of the requirement to provide language assistance services. But the whole point of the SafeRx campaign is that pharmacies have a federal obligation to do so. Pharmacies shouldn’t be given the ability to dodge their legal responsibilities.

Promote Liability & Accountability
SBOP should implement a plan to monitor and assess pharmacies’ compliance with the law.

Modify Prescription Pads
The NYS prescription pad should be revised to reflect if a patient is LEP and, if so, what the primary language spoken is.

If implemented correctly, SafeRx could improve business for pharmacies by improving customer service and consumer loyalty. For the healthcare system as a whole, SafeRx could dramatically reduce the 700,000 emergency room visits and 100,000 hospitalizations that occur every year when patients misunderstand how to take prescription meds [i]—saving the healthcare system over 3 billion dollars per year overall. [ii]  

With millions of New Yorkers who stand to benefit and millions of dollars to be saved, there’s no reason for the SBOP not to get on board with our recommendations.  And with the clock ticking toward when the legislation will take effect, the time to do so is now.

[i] Daniel Budnitz, et al., National Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events, Journal of the American Medical Association (JAMA), 2006; 296 (15):1858-1866.

[ii] William Shrank, et al., Educating Patients About Their Medications: The Potential and Limitations of Written Drug Information, Health Affairs, 2007; 26 (3):731-40.

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Bridging Theory and Practice for Language Rights

Check out a newly published article in the Journal of Health Care for the Poor and Underserved, co-authored by Health Justice Director, Nisha Agarwal, on the importance of language access in the pharmacy setting. This is an area where the evidence about the importance of providing language concordant services for patients who are limited English proficient (LEP) keeps growing and, despite all the discussion in medical circles about “evidence-based” policymaking, we continue to face resistance at state agencies charged with protecting and advancing public health. Instead of collaborative discussions about how to improve access to prescription medications for immigrant communities and reducing health disparities, we hear complaints about how language assistance services might put huge chain pharmacies out of business – immigrant scape-goating at its worst.

We’re taking our fight to the pages of research journals, as well as to the corridors of power in Albany and to the streets until we win. Join us in this effort! Send us an email and let us know that you’d like to join the coalition to ensure Safe Access for Everyone to prescription medications (SafeRx): healthjustice[at]nylpi.org.

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Do You Understand Your Prescription Labels?

We here in NYLPI’s Health Justice Program, along with our partners Make the Road New York, are getting ready to hold a press conference at 12:30pm on Tuesday, December 14 near City Hall at Broadway and Park Place (East side of Broadway).  We will use that opportunity to release our new report detailing our findings from a monitoring study of language access in pharmacies, and to join with consumers, advocates, and State Assemblyman Richard Gottfried, State Senator Jose Peralta, and Councilmember Julissa Ferraras in calling for the state legislature to pass a bill that would ensure standardized prescription drug labels and language assistance services in chain pharmacies all across New York State.

It may seem like  common sense, but prescription drug labels are only effective if patients are able to understand them.  That feeling of confusion upon returning home from the pharmacy and not understanding how to take the medication is universal.  With dozens of ways for a pharmacist to write “take once a day,” it is often challenging for patients to understand and act correctly on just one prescription instruction.  For those who take multiple medications, such as the elderly, and for the over 2.4 million people in the New York who speak English less than “very well” and are therefore considered limited English proficient (LEP), though, the lack of translation and prescription label standardization makes labels literally incomprehensible.

The consequences of patients’ misunderstanding prescription labels can be dire and costly.  Every year, unintended misuse of prescription medications causes over one million “adverse drug events,” resulting in expensive visits to the emergency room, hospitalization, and even death.

Everyone should be given the opportunity to understand their prescription medication labels.  Fortunately, solutions exist to this serious health problem that are simple, inexpensive, and efficient for pharmacies to implement.  Creating easy-to-understand, standardized prescription labels, and providing that information in a patient’s language in person or over the phone, can significantly improve health outcomes.

Since 2007, NYLPI and Make the Road have been championing the issue of safe access to prescription medications in New York State, particularly with regard to language access.  We worked with the New York State Office of the Attorney General to enforce existing laws relating to language access in pharmacies, which resulted in settlement agreements with seven chain pharmacies operating across the state.  We also worked with the New York City Council to pass the Language Access in Pharmacies Act, which requires chain pharmacies in the city to provide translation and interpretation services for LEP consumers filling prescriptions.

This past summer, Make the Road and NYLPI surveyed over 250 chain pharmacies across New York—including Rite Aid, Duane Reade, K Mart, CVS, Pathmark, Target and Walgreens—to determine the extent to which pharmacies were complying with the city law and Attorney General settlement agreements.  Chain pharmacies not bound by local law or the settlement agreements were also surveyed to determine whether additional regulation actually improves access to services for patients.

What we found encourages us that our efforts thus far are significantly improving the health and safety of all New Yorkers.  It also pushes us forward in our work toward making that goal a reality.  Among other findings, our results show that:

  • The settlement agreements and local law have led to significant improvements in the provision of language assistance services compared to when we began this work in 2007.
  • However, nearly 50% of pharmacies surveyed were still unable to state that they met the prescription label translation requirements of the laws.
  • Further, almost 30% of surveyed pharmacies could not state that they provided mandated interpretation services for medication counseling.
  • Pharmacies not subject to the settlement agreements or local law provide the poorest access to limited English proficient consumers.

While the oversight and additional regulation by state and local authorities have had a positive impact on patient access to pharmacies, more needs to be done.  The city law only covers New York City chain pharmacies and the settlement agreement expires in 2013.  In addition to the ongoing language barriers, the fact remains that many consumers, regardless of the language that they speak, continue to have a difficult time understanding the instructions and labels that accompany their medication, and there is little in existing law to help them.

The state bill, championed by Assembly Member Gottfried and State Senator Tom Duane, contains provisions that would ensure that all patients can better understand their prescription medications.  The bill, which would apply to all chain pharmacies across New York, would authorize the State Board of Pharmacy to create a framework for standardized prescription labels that are easier for consumers to understand.  It would also expand upon the legal requirements already contained in the local law and would codify many of the translation and interpretation requirements of the settlement agreements.

We hope you will join us at the press conference, and will sign on to show your support for New York Assembly bill A11627 (Gottfried) and Senate bill 8365 (Duane) and to call on members of the Assembly and Senate to sponsor and support the legislation.

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They Had Plenty of Time: Monitoring Pharmacy Compliance with Language Access Laws

This post is by Rylee Sommers-Flanagan, a summer intern with the Health Justice Program and a student at Emory University in Atlanta, GA.

According to the US Census of 2000, ten years ago over 35% of the then 8 million residents of New York City were foreign born, and 47.6% spoke a language other than English at home. Since then, these numbers have only grown.

Given those demographics, it’s fitting for federal, state and local law to require pharmacies (as well as hospitals, other health care facilities, and all city agencies providing direct public services) to provide language assistance services to limited English proficient (LEP) customers or patients. Language assistance services entail translation (of written documents) and interpretation (of the spoken word). Because New York also requires that pharmacists counsel customers with regard to their prescriptions, both types of service are indispensable.

Even so, when activist organization Make the Road New York teamed up with us to file a civil rights complaint with the New York State Office of the Attorney General (OAG) in July of 2007, the results of the ensuing investigation were predictably disappointing. The OAG found seven chain pharmacies with names you’ll recognize – A&P, Costco, CVS, Duane Reade, Rite-Aid, Target, and Wal-Mart – in violation of the law and came away with seven settlement agreements, requiring newly specific and official translation and interpretation services.

In all cases, the deadline for implementing the required improvements was at latest May 15, 2010. They had plenty of time.  We’re now trying to figure out whether pharmacies have used that time to get in line with their legal obligations.

Unfortunately, verifying compliance may not be so simple. On a recent visit to a CVS/Pharmacy and then a Rite-Aid, I asked which languages they could print on their labels and was promptly informed that no pharmacy employees could answer my questions unless I was a customer. The cold shoulder response makes monitoring pharmacies significantly more challenging, and it seems unlikely to be an accidental roadblock. We’ve heard through our contacts in the industry that many of the pharmacies are trying only to comply with the letter of existing laws and not their spirit.  And we also know they’re resisting language access requirements in other states.  Our allies in California report that pharmacy lobbyists–many from the same companies that signed settlement agreements in New York–are telling regulators on the left coast that it is not possible, difficult or too expensive to provide language assistance services.

This is troubling, to say the least, and patently untrue.  Recently, for example, we spoke with representatives from a an international firm called RxTran that is well-equipped to create a database of translated warnings and instructions for easy use by pharmacists as an integrated part of their work routine. In fact, RxTran designed such an economically feasible and work convenient product—it typically costs less than $2 per day—that even some small, independent pharmacies have purchased database access.

It may be that the chain pharmacies are lazy or greedy and near-sighted (imagine trying to attract customers to whom you are incomprehensible). But for either possibility, we need to remember their pattern of negligence and, now call for the follow up.

Failing to provide accurate translation and interpretation has proven devastating on many occasions. Examples range from the children who vomit endlessly until they arrive in an emergency room (only to discover parents have been administering topical medications orally), to the little old ladies who take eleven times the amount of prescribed medicine (due to faulty translation of the word ‘once’). The United States, for better or worse, has not declared English a national language – can the illness and death ultimately associated with simple language errors really be declared an acceptable side effect of pharmacy arrogance?

Enforcing language access laws may be as difficult as passing them but we, who deserve to comprehend what makes us well or sick, must hold the Rite Aids, Duane Reades and CVSs accountable for that information, in all the languages we speak.

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Why Language Access Matters

This post, by NYLPI’s Health Justice Director, originally appeared on the blog of the National Campaign to Restore Civil Rights.

Every person who reads this likely speaks English, and speaks it well.  Whether we are people of color, people with physical disabilities, members of a religious minority, women, gay, working class or poor, we stand with the vast majority of America in that we enjoy “English privilege.”  Practically speaking, English privilege means this: For over 24 million people in the United States, it is difficult and sometimes impossible to get jobs, hold jobs, feed their families, vote in an election, be on a jury, make doctors’ appointments, take medication, use the courts, receive an education, get a home, keep a home—basically, participate in all of the ordinary and extraordinary features of American life—because they do not speak English.

Consider the experience of María Angela C., a Spanish-speaking woman from New York City who is in the process of learning English but hasn’t mastered it well enough to understand complicated health information.  One day, her 5-year-old son broke out in hives due to an allergic reaction.  She rushed him to the doctor, who wrote her a prescription but did not explain how to take the medication.  When María Angela went to the pharmacy to fill the prescription, the pharmacist also failed to explain how to take the medication and handed her a bottle with instructions in English only.  María Angela took the bottle home, opened it and saw a pink liquid that resembled “pepto,” so she surmised that the medication should be administered orally.  After her son took a spoonful, however, he reacted with extreme disgust, and María Angela became nervous.  She asked a neighbor to translate the label and learned that the medication actually had to be applied topically.  María Angela was devastated.  Her son risked another allergic reaction, or worse, due to the fact that the health care delivery system that she encountered operated in English only, and she did not (yet) have the English-speaking ability to navigate it safely.

María Angela and her son faced a barrier to equal health access, to a basic human need, that the rest of us take for granted.  Though many Americans have felt powerless and overwhelmed in the U.S. health care system, most of us have probably not felt silenced – quite literally unable to ask for or receive help because of the language we speak.  Fortunately, civil rights laws are in place to break this silence.  Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of national origin, which includes language.  In the health care context, this means that hospitals and pharmacies must provide interpretation services and translated medication labels to ensure that individuals such as María Angela can access health services with the same hope as the rest of us: that it will improve well-being, not further compromise it.  Unfortunately, the Supreme Court has, in recent years, begun to interpret the law in such a way that this right to equal access does not have an adequate remedy.  In the 2001 decision of Alexander v. Sandoval, a case about an English-only amendment to the Alabama state constitution, the Court held that private individuals cannot sue in federal court for violations of Title VI unless they can show that they were the victims of intentional discrimination – that is, if they can point to something like a “Whites Only” sign on the front door of the pharmacy.

put the kibosh on virtually all federal litigation under Title VI in the health care arena, among many others.  Advocates have sometimes been able to work around the problem.  For example, our Health Justice Program (HJP) represents Make the Road New York, a Latino community-based organization in New York City, and has successfully approached  government agencies such as the state Attorney General’s office to compel investigations of and settlement agreements with national chain pharmacies that do not provide interpretation services and translated medication labels for their non-English speaking customers.  We have also drafted and lobbied for the passage of language rights laws that would compensate for the erosion of civil rights protections at the federal level.  In fact, this morning, New York City’s Mayor Bloomberg signed the Language Access in Pharmacies Act, which will ensure that, in the future, María Angela and her son can use pharmacies in the five boroughs and have their rights to language assistance services respected.

But what about people living in areas where government agencies are not as receptive to the claims of linguistic minorities, and where local elected representatives do not have the same numbers of immigrant constituents holding them accountable?  What about people like Baltazar Cruz, who went to a hospital in Mississippi to give birth and ended up having her child taken away from her because she didn’t speak English?   In these cases, re-opening the doors of the federal courthouse is crucial.  Language rights are, fundamentally, civil rights, which should have a remedy in every part of our country.  And leaving your health care provider with an understanding of how to care for your child, with that child still in your arms, is a basic right; it should not be a privilege.

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A First for NYC and the Nation

Yesterday, the New York City Council passed the Language Access in Pharmacies Act by a vote of 36 to 7, making it the first jurisdiction in the country to enact legislation ensuring that limited English proficient (LEP) individuals have equal and safe access to prescription medications.  We worked closely with Make the Road New York and the bill’s sponsor, Public Advocate Betsy Gotbaum, to draft the bill, negotiate its provisions and lobby for passage.  You can read/view articles about this in the Gotham Gazette, Channel 7 News, El Diario and the Daily News Blog.

The bill builds upon the agreements reached by the New York State Attorney General with major chain pharmacies in New York State in that it expands the number of pharmacies subject to stricter language access requirements (any pharmacy with 4+ stores), provides for fines and penalties in case of violation and does not expire after 2013, as the agreements do, among other things.

This is a huge victory for immigrant New Yorkers and for anyone concerned with public health, but we’re not quite ready to hang up our hats and call an end to the campaign.  There are a lot of things that the state regulates in terms of pharmacies (and that the city has no power over) that should be improved to ensure that LEP New Yorkers statewide are guaranteed equal access to prescription medications.  So, we plan to take our show on the road: from City Hall to Albany.  Stay tuned for more on these efforts and how you can get involved!

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Hasta La Victoria, Siempre

On Thursday, August 20, 2009, the New York City Council is going to vote on and pass a bill on language rights in pharmacies — the first law of its kind in the country.  We’ll be on the steps of City Hall at 1pm, right before the vote, to celebrate – join us!

This victory is the latest in a series of victories that began in the fall of 2007, when we filed a civil rights complaint on behalf of Make the Road New York against several NYC pharmacies for failing to provide equal access to their services for non-English speakers.  This complaint resulted in settlement agreements with seven of the major chain pharmacies operating in New York, improving access to prescription medications for almost 1 million customers statewide.  Intro 859-A, sponsored by Public Advocate Betsy Gotbaum, expands upon the settlement agreements in important ways: it covers a broader range of chain pharmacies; provides for fines and penalties for violations; and, unlike the settlement agreements, won’t expire in 2013.  (For all of the documents and background materials associated with this campaign, please click here.)

We are proud to be associated with this landmark legislation and to be a part of a truly community-driven campaign for improved health access.  Si, se puede!

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