First Databank

First Databank's MedKnowledge provides prices, descriptions, and collateral clinical information on drugs approved by the US Food and Drug Administration (FDA), plus commonly used over-the-counter drugs, herbal remedies, nutraceuticals and dietary supplements.

First Databank has developed a drug ordering knowledge base that enables physicians to quickly look up and order drugs,.s. Drug orders are generated based on patient parameters such as age, weight, renal and hepatic impairment, thereby reducing lists of candidate drugs to a minimum. The system is expected to affect the number of adverse drug reactions and side effects at facilities that have adopted the electronic drug order entry system, such as Beth Israel Deaconess Medical Center, an affiliate of Harvard Medical School.

A web-based software tool that enables, institution-specific modification of medication alerts using FDB MedKnowledge clinical modules based on clinician input, localized clinical experience, and other available evidence. The tool allows users to edit or turn off individual alerts, track all alert customizations and create an audit record, and view FDB updates in comparison with the user's own modifications. Users can load the results of their modifications directly into their medication decision support system for immediate use in the workflow. The approach follows the normal update process.

The FDB Prizm medical device database provides structured, categorized and normalized information about medical device products that are implanted into patients; hospital and durable medical equipment; and medical supplies. The medical device content comes from a variety of sources such as the FDA, medical device manufacturers and industry data pools. Also, it encompasses additional information from clinical, operational, and financial attributes and codes. Use of this database within supply chain and other information systems is designed to help decision makers to build and maintain device libraries, identify and document medical devices in case of recalls and adverse events, and group and analyze medical device utilization.

A consumer coalition filed separate suits in a Boston, Massachusetts federal court against drug wholesaler McKesson Corporation and First Databank, accusing the companies of artificially inflating drug prices. The lawsuits say that McKesson and FDB conspired from 2002 through 2005 to set the list prices artificially high. The suit against First DataBank accused it of limiting its survey of wholesalers to a single company, McKesson.

The plaintiffs contend that the practices have driven up the wholesale cost of drugs for institutional buyers, including health insurers and government programs such as Medicaid, which in turn has cost taxpayers and insurance buyers billions of dollars. Neither company may reap financial rewards directly from widening the spread between the two benchmarks, but the plaintiffs claim the defendants have another motive, performing favors for their drug industry customers. McKesson claims it does not benefit from a higher average wholesale price. A McKesson spokesman said, "An increase or decrease in branded AWPs has no impact on McKesson's wholesale business or its financials."

In a settlement agreement tentatively approved by the federal court, First Databank will not pay any damages to the plaintiffs, but has agreed to reduce average wholesale prices (AWPs) by five percent for about 2,033 drugs. However, McKesson has chosen to fight the suits. Both firms deny any wrongdoing. McKesson claims it was unaware that it was the only company in First DataBank's survey, and that FDB testified under oath that it never informed McKesson it had restricted its survey to one company.

Stock prices of drug wholesalers and drugstore chains declined in a selloff after reports that FDB's legal settlement could reduce drug middleman costs by at least $4 billion a year.

Health care purchasers say the alleged price fixing adds substantial costs. One plaintiff, the New England Regional Council of Carpenters, estimated the settlement could save it about $400,000 a year, or four to five percent off the $10 million that the union's health fund pays to cover medications for about 18,000 people.

"This case is going to lead payers to demand more transparency in drug pricing," said Alex Sugerman-Brozan, director of the Prescription Access Litigation Project in Boston, which filed the suits. "It's this entire shadowy world that leads to massive overcharging."

• fdbhealth.com - Website
• SFGate.com - 'Unhealthy practices? Lawsuits say companies artificially boosted drug prices', Victoria Colliver, San Francisco Chronicle (December 12, 2006)
• - The Academy of Managed Care Pharmacy has produced a document explaining various drug payment methods. (October, 2007)