Contrary to the expert opinion and research that it has studied in the last two years, the California Board of Pharmacy is being swayed by retailer lobbyists and chain-pharmacy interests against making prescription labels safer for seniors and other Californians. Consumers Union is calling on California residents to submit comments to the Board by March 10th, in support of requiring all pharmacies to print important label information in at least a 12-point font size.
Labels on pill containers can make the difference between life and death when it comes to preventing medication errors. To take medications safely, patients need to easily see and understand the most important parts of the prescription label: the patient name, the name of the drug, and the dosage. In 2007, California legislators required standardized labels across the state. After two years of collecting testimony from experts and input from advocacy groups, the Board was prepared at its meeting in January of this year to pass regulations requiring a 12-point font minimum. But the day before the meeting, the governor appointed a CVS executive to the retail pharmacy slot on the Board, who cast the deciding vote away from the direction the board had been moving and away from meeting the needs of senior citizens. The Board decided to propose a 10-point minimum font standard instead of 12-point.
Tiny print can lead to harmful or even deadly errors, particularly for the 80% of senior citizens who use one or more prescription drugs. In its 2006 report Preventing Medication Errors, the Institute of Medicine estimated that more than 500,000 preventable medication errors occur every year among Medicare beneficiaries in the outpatient setting, where patients have the main responsibility for taking their medication. The report found that drug labeling is a main source of medication error, and recommended the development of safer standards for drug labeling. Ramon Castellblanch, the public member on the Pharmacy Board and an Associate Professor of Health Education at San Francisco State University, told the Board at its last meeting that, according to his calculation, at least 300,000 California seniors will be directly affected by the consequences of Board lowering the minimum font size — they would have been able to read the medication instructions on 12-point font labels, but will likely be unable to read the 10-point font instructions.
The Pharmacy Board admits that its vote for a 10-point minimum is “contrary to underlying research and data.” In the Board draft comments responding to testimony and evidence presented on the issue, the Board stated it had received overwhelming support for a 12-point font minimum – from the National Association of Boards of Pharmacy, all of the research and data seen by the Board, testimony of health literacy experts, and senior representatives. The Board further states that there was no evidence or data presented indicating that a font size less than 12-point was optimal. Arguments made by chain pharmacy representatives that there would be additional cost or environmental damage created by larger labels were not supported by any tangible evidence found by the Board.
As the Board has acknowledged, not a single piece of evidence supported their vote for 10-point font size. The seniors who had supported this patient-friendly legislation expressed outrage at the Board’s meeting in February, and Consumers Union along with several other groups testified that the Board should return to its original proposal of a 12-point font minimum.
Before the decision was made to propose a smaller 10-point font size, the Board was also prepared to make labels more accessible to limited-English-proficient Californians by requiring pharmacies to provide oral translation of the most-needed information when requested by the patient. New York City law, notably, requires chain pharmacies to translate prescription drug labels both orally and in writing. But the Pharmacy Board weakened its proposal so that it may not protect patients with limited English proficiency, a group that is 50% more likely to report having trouble understanding labels. If New York City can help patients avoid pharmacy medication errors, why can’t the state of California?
The Board’s actions are not final. Californians may submit a comment to the Board on the revised regulations until 5 P.M. on Wednesday, March 10th. Click here to tell the California Pharmacy Board to make medication labels safer! Consumers Union will continue our push for safer prescription labels to prevent deadly medication errors.
Guest blog post written by Syed Sayeed, Policy Analyst at Consumers Union’s West Coast Office.