Saturday, June 1, 2013

Ontario Racing Commission: Notice to the Industry--citing US RMTC Caution re: Compounding

Posted by  -  - 

Avoiding inadvertent positive tests:

ORC licensees reminded to be vigilant when medicating horses
In an effort to provide horsepeople with relevant, useful information, the Ontario Racing Commission (ORC) has released its first public YouTube video. In this new episode, Lehman and ORC Manager of Veterinary Services Dr. Adam Chambers discuss how trainers can avoid inadvertent positive tests.
Commencing June 1, the video will be broadcast in-house at Ontario racetracks with the cooperation of ON Track Media Entertainment.
ORC YouTube- Avoiding Inadvertent Positive Tests
Here is a summary of the video content, as well as more information on how to avoid inadvertent positive tests.
1. Read the CPMA Schedule of Drugs booklet – thoroughly!
Trainers should familiarize themselves with the full contents of the booklet. Go beyond simply reading the drug name and its withdrawal time. Be sure to check the dosage, the route of administration, and how many times the drug was given.
2. Use a reliable source for your medications
Purchase your medications from reliable, recognized sources, such as your licensed ORC veterinarian. Some sources, like some internet sites do not label these products accurately. ORC has tested products ordered from internet sites. While oftentimes the names of these products infer a powerful performance enhancing effect, the true contents of the majority of these products are benign at best and potentially harmful at worst.
Trainers should also be aware of the risks of using compounders. Analysis of some compounded medications revealed drug content that was often quite different than stated quantities.
The US-based Racing Medication & Testing Consortium (RMTC) is cautioning US horsepeople, and shared a report on its website. “Compounding pharmacies are going largely untracked, unregulated and under-inspected by states across America.”
RMTC website link to report - http://rmtcnet.com/content_headlines.asp?id=&s=&article=1474
3. Do not “over medicate” your horse
Trainers are urged to minimize the number of drugs given to a horse. For example, if your horse needs an anti-inflammatory, administer only one – not two or three. There are few reliable studies examining how administering multiple drugs will affect individual withdrawal times.
Be vigilant with respect to all ingredients
According to Dr. Chambers, trainers – and veterinarians – should satisfy themselves of the true contents of anything administered to horses prior to racing. “You need to be vigilant with respect to all ingredients. Check the label and ask questions of those dispensing products.”
Steve Lehman Executive Director
quoted from here
 

Lamar Alexander, Tennessee’s senior U.S. senator, cooments on Compounding

Last year’s fungal meningitis outbreak was a nightmare for Tennesseans. Our state alone suffered 152 cases, including 15 deaths.
The tragedy would have been much worse if not for the heroism of state officials with the Department of Health who discovered the problem and helped to identify the cause. Their work prevented more people from getting sick and saved countless lives.
Last week, the Senate’s health committee completed work on legislation I sponsored to try to make sure this never happens again. The next step is consideration by the full Senate.
I believe most of the problem with the meningitis outbreak was a lack of clear accountability for regulating the large Massachusetts pharmacy that compounded (or mixed) the tainted drugs. There was confusion between the U.S. Food and Drug Administration (FDA) and the Massachusetts pharmacy board over who was responsible for overseeing businesses that functioned in between a traditional corner drug store and a drug manufacturer.
The primary goal of our legislation is to erase that confusion. My experience as governor was that whenever I gave a job to more than one person, it often came back not done. But when I put one person “on the flagpole” and in charge, it was surprising to see how assigning responsibility got it done.
Adm. Hyman Rickover, the father of the nuclear Navy, told his submarine captains that if anything went wrong with the ship’s reactor, the captain’s career was over. As a result, there never has been a death from a problem with a Navy submarine reactor
continue reading here

Meningitis lawsuits to stay local for now

In a major victory for a handful of the local victims of a nationwide fungal meningitis outbreak, a federal judge has ruled that, at least for now, their cases will proceed before a circuit court judge in Nashville and could eventually be tried by a local jury.
In a 33-page ruling issued late Friday, U.S. District Judge F. Dennis Saylor IV in Boston ruled that those victims who have sued the health care providers who gave the tainted steroid shots but not the bankrupt compounder who provided the drugs in the first place can remain in courts in Tennessee and at least two other states.
The more than 100 suits that either directly or indirectly assert claims against the New England Compounding Center, which produced the tainted methylprednisolone acetate, will be consolidated in Saylor’s court room.
The cases that can remain in Nashville include the suit brought by Wayne Reed of Nashville, a victim of Lou Gehrig’s disease who lost his wife and primary caregiver in the meningitis outbreak.
Reed’s and three other local suits were filed against Saint Thomas Outpatient Neurosurgical Center, where the four got their injections, but not the drug compounding firm.
Mark Chalos, a Nashville attorney representing some of the victims, said the ruling means that “a narrow subset of cases” will stay in state courts “at least for now.”
“This is an important step on the path to justice for the families who were harmed,” he said.
continue reading here

FDA Budget May Need To Be Trimmed 5% In FY 2015

By Derrick Gingery / Email the Author / May 31, 2013 
Word Count: 829 / Article # 14130531005 / Posted: May 31 2013 6:10 PM


Executive Summary


OMB memo states that agencies should reduce net discretionary spending from the initial FY 2015 estimate and provide options for additional cuts.

CBO Says House Rx Tracing Bill Would Generate $24 Million Over 8 Years

The House version of drug tracing legislation would increase federal revenue by $24 million from 2015 to 2023 because of licensing fees, according to an analysis released Friday (May 31) by the Congressional Budget Office. The full House will consider the bill Monday under suspension of the rules alongside legislation reauthorizing animal drug user fees, according to the majority leader's schedule.

 
quoted from here

USP Key Issue: Standards for Veterinary Drugs May 31, 2013

Original Posting: 31–May–2013

Contacts

Consistent with its commitment to provide public standards for the quality, consistency, purity, identity, and strength of all medicines, USP is advancing its standards for drugs for veterinary use. These standards include monographs and general chapters (including those devoted to veterinary drug topics) applicable to any articles recognized in the United States Pharmacopeia–National Formulary (USP–NF), whether in the form of a manufactured or a compounded preparation. USP has been active in setting standards for veterinary drugs for many years, and recently has expanded its mission statement to acknowledge this.

Current Activities

Solubility Criteria for Veterinary Drugs

A summary of the discussions during the Workshop on Solubility Criteria for Veterinary Productsthat took place at USP headquarters in Rockville, MD on November 7–8, 2012 will be published in Pharmacopeial Forum 39(4), together with Stimuli articles that will provide explanations for the approaches to be included in a new USP General Chapter <1236>, provisionally titled Determination of Thermodynamic Solubility of Active 
Pharmaceutical
 Ingredients for Veterinary Species.

For additional information, contact Margareth Marques, Ph.D., Senior Scientific Liaison (mrm@usp.org or +1-301-816-8106).

Veterinary Drugs Stakeholder Forum

On November 9, 2012, USP held its first Veterinary Drugs Stakeholder Forum, which provided an opportunity to educate stakeholders on USP activities, help USP staff understand veterinary drug issues, and discuss compendial issues and emerging USP initiatives that may affect veterinary drug stakeholders. USP anticipates holding a second Veterinary Drugs Stakeholder Forum on November 20–21, 2013.

Compounding Monographs

The USP–NF includes standards of identity  continue reading here

ASCRS Urges Exemption for Office Use in Drug Compounding Legislation

This week, ASCRS sent a letter to the Senate Committee on Health, 
Education
, Labor, and Pensions (HELP) regarding S. 959, the Pharmaceutical Compounding Quality and Accountability Act, requesting that the bill be amended to exempt compounded biologics and other Food and Drug Administration (FDA) marketed drugs so that ophthalmologists have access to drugs that may be administered in their offices without specific patient prescriptions. The bill was introduced to address concerns over safety at compounding pharmacies in the wake of the deadly 
meningitis
 outbreak last fall. The bill would consolidate oversight of these pharmacies under the FDA and tighten access to compounded drugs to the point that physicians would not be permitted to stock compounded drugs in the office for emergent cases. S. 959 passed the Senate HELP committee without this exemption. ASCRS is working in conjunction with the American Academy of Ophthalmology to ensure the final version of the bill includes office use exemptions.

quoted from here

Strengthened Accreditation Process Charles Leiter, President and CEO of Leiter’s Compounding Pharmacy, cited in support of PCAB’s renewed survey policy. San Jose, CA (PRWEB) June 01, 2013


Supporting a strengthened accreditation process, Leiter’s Compounding Pharmacy commended the Pharmacy Compounding Accreditation Board (PCAB) in its effort to distinguish accredited compounding pharmacies from unaccredited ones. PCAB announced that it will be conducting unannounced surveys of compounding pharmacies seeking to renew accreditation from the group starting September 1, 2013.
“We welcome the unannounced surveys,” said Charles Leiter, President and CEO of Leiter’s CompoundingPharmacy in San Jose, CA. “This new process helps level the playing field for all of us. Now if a hospital, patient or doctor needs a compounded preparation and they select a PCAB accredited pharmacy, they can feel comfortable with their decision.”
Leiter’s Compounding Pharmacy is a PCAB Accredited pharmacy and offers sterile and non-sterile compounds both locally and nationwide.

Florida Board of Pharmacy Agenda and Materials for Meeting June 4-5, 2013

June 4-5, 2013
DoubleTree Miami Airport Convention Center
711 N.W. 72nd Avenue
Miami, FL 33126
(305) 261-3800

AGENDA
DEPARTMENT OF HEALTH
BOARD OF PHARMACY
FULL BOARD MEETING
June 4-5, 2013
DoubleTree Miami Airport Convention Center
711 N.W. 72
nd
Avenue
Miami, FL 33126
(305) 261-3800
PLEASE TURN OFF ALL CELL PHONES, PAGERS AND BEEPERS DURING THE MEETING.
THANK YOU.
Board Members Board Staff
Albert Garcia, BPharm, MHL, Chair, Miami Mark Whitten, Executive Director
Jeffrey J. Mesaros, PharmD, Vice Chair, Tampa Tammy Collins, Program Operations Administrator
Leo J. “Lee” Fallon, BPharm, PhD, The Villages Jay Cumbie, Regulatory Specialist II
Debra B. Glass, BPharm, Tallahassee
Cynthia Griffin, PharmD, Jacksonville Board Counsel:
Gavin Meshad, Consumer Member, Sarasota David Flynn, Assistant Attorney General
DeAnn Mullins, BPharm, Lynn Haven
Lorena Risch, Consumer Member, Bradenton Department of Health Staff
Michele Weizer, PharmD, Boca Raton John J. Truitt, Assistant General Counsel
Participants in this public meeting should be aware that these proceedings are being recorded and
that an audio file of the meeting will be posted to the board’s website.
Tuesday, June 4, 2013 - 9:00a.m.
TAB 1: REPORTS
A. Chair’s Report - Albert Garcia, BPharm, MHL, Chair
          1.  NABP 109
th
Annual Meeting – St. Louis, MO
    2.  Letter from Dr. Armstrong, MD, FACS
3.  Federal Legislation Draft Proposal on Pharmaceutical Compounding
B. Executive Director's Report - Mark Whitten
1.  Gavin Meshad
i. Prescription Drug Abuse Committee Update
2.  Michele Weizer
i. Compounding Rules Committee Update
3. Correspondence
i.  Martin R. Dix – Akerman Senterfitt
ii. Edwin Bayo, Esquire
     iii. Faustino Gonzalez, MD, FACP, FAAHPM – Hospice
   iv. Robert V. Burwen, C.Ph – Hospice
4.  Request for PDM at Multiple Locationsi. TeamCare Pharmacy
5.  Legislative Update
C. Attorney General's Report - David Flynn, Assitant Attorney General
1.  Rules Report
D. Prosecuting Attorney's Report - John Truitt, Assitant General Counsel
1. Prosecuting Services Report
E. Chief Investigative Services Report - Jeane Clyne
TAB 2: BUSINESS - Albert Garcia, BPharm, MHL, Chair
A. Ratification of Issued Licenses/Certificates & Staffing Ratios
1. Pharmacist (Licensure)(Client 2201) – 117
2. Pharmacist (Exam Eligibility)(Client 2201) - 93
3. Pharmacist Interns (Client 2202) – 128
4. Registered Pharmacy Technicians (Client 2208) - 893
5. Consultant Pharmacist (Client 2203) – 33
6. Nuclear Pharmacist (Client 2204) – 1
7. Pharmacist/Facilities (Client 2205) – 106
8. Registered Pharmacy Technician Ratios (2:1 or 3:1) – 54
9. Pharmacy Technician Training Program (Client 2209) – 23
10. CE Providers – 14
11. CE Courses – 23
12. CE Individual Request (Approved) – 0
13. CE Individual Request (Denied) – 0
B. Review and Approval of Minutes
1. April 2-3, 2013 Meeting Minutes
   C. Proposed 2014 Meeting Dates and Locations
   D. Presentations
   1. Rebecca Poston – PDMP (Prescription Drug Monitoring Program)
     2. Susan Langston – Drug Enforcement Agency (DEA)
Wednesday, June 5, 2013 - 8:00a.m.
TAB 3: DISCIPLINARY CASES - John Truitt, Esq. & Albert Garcia, BPharm, MHL, Chair
SETTLEMENT AGREEMENTS - APPEARANCE REQUIRED
A-1  Robert Edward Levy, R.Ph., Case No. 2011-11766
(Garcia/Mesaros)
A-2 Justa Almeida, R.Ph., Case No. 2011-10399
    (Fallon/Weizer)
A-3 Alan E. Wingerter, R. Ph., Case No. 2012-12447
(Fallon/Risch)
A-4 Tyronda Sanks, RPT, Case No. 2012-14090
(Mesaros/Mullins)
A-5 Hal Goldman,  R.Ph., Case No. 2012-04357
(Risch/Glass)
A-6 Terry Dean Mundorff, R.Ph., Case No. 2012-13902
(Fallon/Risch)
A-7 Zhaoqi Zhu, R.Ph., Case No. 2012-16132
(Mullins/Glass)A-8 Steven Hunter, R.Ph., Case No. 2009-08335
(Fallon/Risch)
DETERMINATION OF WAIVERS
DOW-1 L & E Pharmacy, Corp., Case No. 2012-09709
                                              (Risch/Glass)
DOW-2 Your Neighbor Pharmacy, LLC, Case No. 2012-09807
(Glass/Meshad)
DOW-3 Neighbors Pharmacy, Inc., Case No. 2012-05736
(Weizers/Mesaros)
DOW-4 Healthy Options, Inc., Case No. 2012-15844
(Fallon/Meshad)
DOW-5 Alene Lavon Thomas, RPT, Case No. 2012-09425
(Glass/Mullins)
DOW-6 Apollo II Services, Inc., Case No. 2011-19015
(Fallon/Risch)
DOW-7 Teresa Hilliard Faulkner, RPT, Case No. 2011-16981
   (Fallon/Risch)
   DOW-8 S C I Medical Supply, PH, Case No. 2012-09140

Colorado Board of Pharmacy Special Meeting to Be Held June 5, 2013 Regarding Proposed Amendments and Additions to Rules-- copy of Agenda Attached

Colorado State Board of Pharmacy Special MeetingDate: 06/05/2013 - 06/05/2013 Time: 10:00 AM - 12:00 PM Title: Colorado State Board of Pharmacy Special Meeting Location: 1560 Broadway, Rm 1250A, Denver,CO 80202
This is a Special Meeting of the Colorado State Board of Pharmacy, which will also be held via Webinar at https://www1.gotomeeting.com/register/807345993 ,  to solicit feedback from potenial stakeholders regarding proposed amendments and/or additions to Board Rules 3.00.21, 3.00.22, 3.00.55, 3.00.90, 3.01.00, 4.00.00, 5.00.00, 15.00.00 and 23.00.00.
Attachment(s):
File
June Agenda.pdf 

Colorado Board of Pharmacy March 2013 Minutes--including discussion of compounding task force

can be viewed here

Colorado Board of Pharmacy Answers Question Regarding Compounding Pharmacy Shipping to Second Pharmacy to Dispense Patient Prescription.



The Board reviewed an inquiry regarding whether Colorado law permits a pharmacy to prepare a sterile compound per prescription, and then ship the prescription to a second pharmacy to be dispensed. After careful consideration of the available information, the Board determined that Colorado law does not permit a pharmacy to prepare a sterile compound pursuant to a prescription order, and then ship the prescription to a second pharmacy to be dispensed.

source found here

Colorado Board of Pharmacy Refers Cases Against to Pharmerica and Wedgewood Village Pharmacy to State of Residence; in another case against Wedgewood Board votes unanimously to refer case for discipline


Pharmerica, OSP 5137 2012-6857
The Board voted unanimously to table further consideration of this case and refer the matter to the Indiana Board of Pharmacy.
Wedgewood Village Pharmacy, OSP 5464 2012-6859
The Board voted unanimously to table further consideration of this case and refer the matter to the New Jersey State Board of Pharmacy.



Wedgewood Village Pharmacy, OSP 5464 2012-6732
The Board voted unanimously to refer the case to Executive Session.
After Executive Session, the Board voted unanimously to refer the case for discipline.



quoted from here

Colorado Board of Pharmacy Issues Complaint Against Pencol Compounding Pharmacy


Pencol Compounding Pharmacy, PDO 154
The Board reviewed an Agenda Memorandum from Ms. Martin and Mr. Gassen regarding recent inspections of Pencol Compounding Pharmacy. The Board voted unanimously to initiate a complaint against Pencol Compounding Pharmacy’s prescription drug outlet registration.

quoted from here

KUDOS to Colorado State Board of Pharmacy for Reaching out to Colorado Medical Board and the Colorado State Board of Veterinary Medicine for additional practitioners wishing to join the Compounding Task Force!!!


California Board of Pharmacy files Complaints Against Indio Medical Pharmacy, La Jolla Discount Pharmacy, Southern California Compound Pharmacy, Westside Pharmacy--All Relating To Compounding Issues


Site Licenses
Indio Medical Pharmacy, PHY 21267, Administrative Case AC 4569
Indio, CA
Accusation Filed 4/4/2013, Case Pending.
View the accusation
La Jolla Discount Pharmacy, PHY 38070, Administrative Case AC 4572
La Jolla, CA
Accusation Filed 4/4/2013, Case Pending.
View the accusation
Southern California Compounding Pharmacy, LLC , LSC 99510, Administrative Case AC 4671
San Diego, CA
Accusation Filed 04/2012; Case Pending
View the accusation
Westside Pharmacy, PHY 15178, and LSC 99245, Administrative Case AC 4385
Fresno, CA
Accusation Filed 4/28/2013, Case Pending.
View the accusation

Idaho Board of Pharmacy 2013 Pharmacy Administrative Rule and Statue Changes-Several Relate to Compounding


2013 Pharmacy Administrative Rule and Statute
Changes
On April 4, 2013, four dockets of rule changes took effect, as
detailed in the March 2013 Newsletter. On July 1, 2013, the following
changes to an administrative rule and sections of Idaho Code
will become effective. Copies of the pertinent docket of rules and
bills are available on the Idaho State Board of Pharmacy’s Web site.
Engrossed versions of Idaho Code and the Board’s administrative
rules are expected to be available later this summer.
House Bill 239 gives the Board statutory authority to address
compounding and the distribution of compounded drug product
in rule, as well as extending to all pharmacies the sale of minimal
quantities of prescription drugs to licensed practitioners for office
use, without required wholesale licensure. Please see the Board’s
Web site for a draft version of such subsequent rules; the Board is
currently accepting public comment on this draft.
House Bill 16 allows a pharmacist or practitioner to furnish another
pharmacist or practitioner information legally obtained from
the Board’s Prescription Monitoring Program database.
House Bill 17 (HB 17) mainly expands the practice of pharmacy
into Idaho, with considerably more regulation of such persons,
practices, and practice sites; however, the bill also deletes outdated
practices and contains several non-substantive changes. HB 17
merges the Out-of-State Mail Service Pharmacy Act into the Idaho
Pharmacy Act, and defines central drug outlet, central pharmacist,
mail service pharmacy, nonresident, pharmacist-in-charge (PIC),
and centralized pharmacy services, which means the processing by
a central drug outlet or central pharmacist of a request from another
pharmacy to fill, refill, or dispense a prescription drug order, perform
processing functions, or provide cognitive or pharmaceutical care
services. Each function may be performed by the same or different
persons and at the same or different locations. All persons and
business entities engaging in the practice of pharmacy into Idaho,
including but not limited to pharmaceutical care services, must be
licensed and registered, except nonresident pharmacists practicing
pharmacy into Idaho who are employed by and practicing for an
Idaho registered nonresident mail service pharmacy. All nonresident
mail service pharmacies and central drug outlets must also have a
PIC or director who is licensed or registered by the Board.
Please note that nonresident pharmacist registration is a lower
standard when compared to pharmacist licensure, as pharmacist
registration does not require an applicant to reciprocate through
the National Association of Boards of Pharmacy® or pass an Idahobased
Multistate Pharmacy Jurisprudence Examination®. However,
the Board may take any action against a nonresident pharmacist
registrant that it can take against a pharmacist licensee for violations
of the laws of Idaho or the state in which the pharmacist resides.
Additionally, the Board may take any action against a nonresident
drug outlet that it may take against its agents and employees. A successful
applicant for a nonresident central drug outlet, mail service
pharmacy, or pharmacist registration or licensure must comply with
the Board’s laws and rules unless compliance would violate the laws
or rules in the state in which the registrant is located, except a technician
shall not exceed the practice limitations for technicians in Idaho
and a pharmacist shall only substitute and generically select drug
products in accordance with Idaho law and shall not exceed Idaho’s
pharmacy staffing ratio. Additionally, the Board may issue an order
likewise suspending, revoking, restricting, or otherwise affecting
the license or registration in Idaho, without further proceeding, as
Drug Enforcement Administration or another state licensing board
with authority over a licensee’s or registrant’s professional license
or registration has issued. Also, if the Board conducts a nonresident
inspection, the nonresident drug outlet shall pay the costs of such
inspection. Lastly, HB 17 reestablishes the original out-of-state mail
service pharmacy fees for all nonresident mail service pharmacies
and central drug outlets: $500 for initial registration and $250 for
renewal.
Docket 27-0101-1205 reiterates some of HB 17 for ease of reading
the rules. Remote office location is defined and allowed with certain
security requirements. While the category of “telepharmacy across
state lines” is absorbed into the new nonresident rule and statute, the
existing $250 registration fee for “telepharmacists across state lines”
is expanded to all pharmacist registrants, but pharmacist licensure
fees remain unchanged. New Rule 029 details which pharmacists
practicing pharmacy in or into Idaho need to be registered or licensed.
The registration category of “telepharmacist across state
lines,” who practice from nonresident institutional pharmacies, is
expanded to all nonresident pharmacists who practice from within
a pharmacy. Unless statutorily exempted (a nonresident pharmacist
working for a mail service pharmacy) or a nonresident PIC or director,
all other pharmacists practicing pharmacy in or into Idaho
must be Idaho licensed, including those practicing from a central
drug outlet that is not a pharmacy and remote office locations. Upon
applying, nonresident central drug outlets and mail service pharmacies
must submit an executive summary describing the centralized
pharmacy services to be performed.
Docket 27-0101-1205 also addresses practice standards. For
example, Rule 320 mandates that the independent practice of
pharmacy is not to be construed to excuse compliance with the
rules governing centralized pharmacy services. The independent
practice of pharmacy rule’s minimal standards are designed to
recognize and regulate pharmacist activities outside of a drug
outlet or institutional facility, such as at a health fair. Rule 610’s
expanded regulation pertains to centralized pharmacy servicessuch as
providing cognitive services for an institutional pharmacy,
remote data entry, and central fill. A pharmacy may centralize
pharmacy services to another Idaho registered business entity, to
be performed at a pharmacy, central drug outlet, or remote office
location, pursuant to a written contract, policies and procedures,
certain training, appropriate communication, a common electronic
file (or other secure technology), a continuous quality improvement
program, audit trail documentation, and privacy considerations. For
an institutional pharmacy, centralized pharmacy services are only
allowed for the limited purpose of ensuring that drugs or devices
are attainable to meet the immediate needs of patients or residents
of the institutional facility.
quoted from Idaho Board of Pharmacy June 2013 Newsletter


Iowa Board of Pharmacy Reminder That All Iowa Pharmacies Respond to the Following Survey


Compounding Survey
The Board has requested that all Iowa pharmacies respond
to the following survey. Responses may be sent via e-mail to
terry.witkowski@iowa.gov. Please respond by July1. Are you compounding prescription or over-the-counter
(OTC) drugs at your pharmacy?
2. If you are engaged in compounding, what type of compounding
is being done (eg, sterile, nonsterile, OTC)?
3. Does your pharmacy ship compounded products to
other states?
4. Are your pharmacists, technicians, or the pharmacy
itself accredited?
5. If accredited, what is the name of the accrediting body?
6. Are all compounds dispensed pursuant to a patientspecific
prescription?
7. If compounds are distributed for “office use,” what is the
percentage of total compounded prescription volume?
8. Does your pharmacy have a separate compounding
area within the prescription department? If so, please
describe.
9. Are you compounding any commercially available
products? If so, what products are being produced and
in what quantities?
10. Does your pharmacy document and track adverse drug
events associated with compounded drug products?

quoted from Iowa Board of Pharmacy June 2013 Newsletter

Iowa Board of Pharmacy Clarification on Compounded Preparations


Clarification on Compounded
Preparations
Iowa Board of Pharmacy Subrule 657 IAC 20.3(1) allows
the compounding of a commercially available product only if
it is necessary to meet the unique medical need of a patient.
The complete text of that subrule is provided below. Pursuant
to 657 IAC 20.2, all compounding, regardless of the type
of product, is to be done pursuant to a prescription and the
prescription must be based on a valid pharmacist/patient/prescriber
relationship. Subrule 657 IAC 20.3(4) allows for the
preparation of non-patient-specific products for “office use” if
the product is administered to an individual patient by the prescribing
practitioner in a professional practice setting. Subrule
657 IAC 20.3(4) also allows a pharmacy to prepare and sell
to a hospital pharmacy a compounded drug product prepared
pursuant to a prescriber’s authorization for administration to a
specific patient. Iowa law and rules have never allowed a pharmacy
to prepare and sell to a hospital pharmacy compounded
preparations in the absence of a prescription. Such activity is
considered manufacturing. This would include the preparation
of sterile products such as outsourced compounded solutions,
IVs, or injectables.
657 Iowa Administrative Code – 20.3(1) Compounding
commercially available product. Based on the
existence of a pharmacist/patient/prescriber relationship
and the presentation of a valid prescription,
pharmacists may compound, for an individual patient,
drug products that are commercially available in the
marketplace, if the compounded product is changed
to produce for that patient a significant difference, as f
authorized by the prescriber, between the compounded
drug and the comparable commercially available drug
product, or if use of the compounded product is in the
best interest of the patient. “Significant difference”
would include the removal of a dye for a medical reason
such as an allergic reaction. When a compounded
product is to be dispensed in place of a commercially
available product, the prescriber and patient shall
be informed that the product will be compounded

quoted from Iowa Board of Pharmacy June 2013 Newsletter

Kentucky Board of Pharmacy Issues a Reminder About Compounding Issues


Compounding Issues
In line with FDA’s statement, pharmacists are reminded that 20 CSR
2220-2.200(9) provides:
Compounding of drug products that are commercially available
in the marketplace or that are essentially copies of commercially
available Federal [Food and] Drug Administration (FDA) approved
drug products is prohibited. There shall be sufficient
documentation within the prescription record of the pharmacy
of the specific medical need for a particular variation of a commercially
available compound.

quoted from Kentucky Board of Pharmacy June 2013 Newsletter

Kentucky Board of Pharmacy Hires a New Pharmacy and Drug Inspector


New Pharmacy and Drug Inspector
Amanda Harding, RPh, began working as a pharmacy and drug
inspector for the Board on May 1, 2013. She is a 2008 graduate of the
University of South Carolina College of Pharmacy. Amanda’s pharmacy
background consists primarily of working in community pharmacy. She
was a pharmacy manager for Walgreens from 2009 to 2013. She is a
resident of Louisville, KY, and will be inspecting Louisville and some
surrounding counties.

quoted from Kentucky Board of Pharmacy June 2013 Newsletter

New Mexico Board of Pharmacy Proposed Changes to Compounding Rules


During the April 18-19, 2013, New Mexico Board of Pharmacy
meeting, three regulation changes were made. One of  these
regulation changes is discussed below and relates to compounding

16.19.30.9 NMAC – Compounding of Nonsterile Pharmaceuticals;
Operational Standards. This regulation revision
states that a pharmacy may no longer compound for a prescriber’s
office use. The wording allowing for office use compounding
was removed from the regulation. A compounded
medication may be sold by a pharmacy by prescription only.
The labeled compounded product is sold after receipt of a
valid prescription is issued to a specific patient.
All Board regulation changes are heard in open session
during Board meetings. Links to the proposed changes are
available online. Go to the Board Web site and click on the
agenda for the Board meeting. There you will find a link to
a proposed regulation change. Public and professional comments
are welcome. Please submit comments to the Board
through written correspondence at least 15 days prior to the
Board meeting, or you may appear in person to express your
opinion.
quoted from New Mexico Board of Pharmacy June 2013 Newsletter

CDC Website Regarding Main Street Family Pharmacy

The Centers for Disease Control has established a web site providing twice weekly updates on the investigation of suspected investigations linked to preservative-free methylprednisolone acetate 80 mg/mL injections compounded by Main Street Family Pharmacy.  The CDC website can be viewed here

North Dakota Board of Pharmacy Explains Scheduling of Tramadol


Scheduling of Tramadol
North Dakota House Bill 1070 passed the North Dakota House
and Senate and was signed by Governor Jack Dalrymple. This billincluded revisions to Schedule I through V controlled substances
(CS) based on federal Drug Enforcement Administration scheduling
changes. This year, the bill included scheduling of multiple spiced
cannabinoids and substances marked as bath salts as Schedule I CS.
The other important revision within this bill is the addition
of tramadol and tramadol-containing products as Schedule IV
substances. An initial inventory should have been taken after the
date of scheduling, and the handling of prescriptions for tramadolcontaining
products should conform to the requirements set forward
in state law. As a reminder, North Dakota law does allow electronic
prescribing of CS outside of the stricter federal standards. Since
tramadol, at this time, is only a state CS, the electronic prescribing
of prescriptions for tramadol is not subject to federal regulations.

quoted from North Dakota Board of Pharmacy June 2013 Newsletter

North Dakota Board of Pharmacy Explains Repackaging Rules


Administrative Guidelines for Repackaging of
Prescriptions
Repackaging by provider pharmacies or consultant pharmacists
for patients in long-term care facilities who receive medications
in packaging that does not conform to the medication distribution
system, chosen by the facility, is appropriate under these guidelines:
1. Medication is delivered to the facility or the repackaging
pharmacy so storage and handling under United States Pharmacopeia
guidelines is assured.
2. The dispensing pharmacy provides the manufacturer’s original
lot number and expiration date.
a. If no lot number is provided, an alternate number will be
assigned by the repackaging pharmacy. If there is a recall
of medication dispensed without the original lot number,
the recall will affect all of the named drug.
b. The repackaging pharmacy will assign an expiration date
not more than six months from the date of dispensing by
the original pharmacy, or the original expiration date,
whichever is shortest.
3. A log must be kept by the repackaging pharmacy containing
the following information:
a. Patient’s name
b. Name, address, and phone number of original dispensing
pharmacy
c. The prescription number of the original dispensing pharmacy
d. Date of dispensing by the original dispensing pharmacy
e. Expiration date assigned by the original dispensing pharmacy,
if available
f. The manufacturer’s lot number or the number assigned by
the original dispensing pharmacy, if available
g. The name of the product and identification of the manufacturer
h. The quantity of product received and repackaged
i. The prescription number assigned by the repackaging
pharmacy
j. Lot number assigned by the repackaging pharmacy or
indication that the manufacturer’s original lot number
was used
4. The repackaging pharmacy is responsible for storage of the
unused portion of the prescription until redistribution to the
facility.
5. Charges for repackaging can be borne by the original dispensing
pharmacy or the facility, but cannot be included by the
consultant or repackager as part of another service. These
charges must be billed separately to avoid the appearance
of kickbacks. Medicaid does not allow repackaging charges
directly to the department by the pharmacy. The patient may
not be charged separately, as the distribution system is a
requirement of the nursing facility and should be included in
their rate. The cost is allowable by Medicaid on the facility
cost report.
6. The repackaging pharmacist is the final decision maker as
to whether the repackaging will be done, and the product
utilized by the patient.

quoted from the North Dakota Board of Pharmacy June 2013 Newsletter

Tennessee Board of Pharmacy Meeting Dates and an Open Invitation for all Pharmacists and the General Public to Attend


Tennessee Board of Pharmacy Meeting Dates
The Board extends an open invitation for all pharmacists as well
as the general public to attend its bimonthly meetings in Nashville.
The following dates are scheduled for 2013:
♦♦ July 9-10, 2013, Iris/Poplar Room – 227 French Landing
♦♦ August 28, 2013, Poplar/Iris Room – 227 French Landing
♦♦ August 29, 2013, Iris Room – 227 French Landing
♦♦ November 13-14, 2013, Iris Room – 227 French Landing
Please check the Board Web site as these dates can be subject
to change. Meetings generally begin at 9 am.

Tennessee Board of Pharmacy Opinions Regarding Repackaging


Board Opinions
At the May 14, 2013 meeting, the Board stated that Tennessee
Board of Pharmacy Rule 1140-04-.10 is interpreted to allow pharmacists
in an institutional setting to return and use medication that is
either in unit-dose packaging or unopened commercially prepackaged
containers and, “. . . in the professional judgment of the pharmacist
in charge or designee, the medications or related materials meet all
federal and state board standards for product integrity. . .” Review
the following link for the rule in its entirety: www.state.tn.us/sos/
rules/1140/1140-04.pdf.
At the same meeting, Tennessee Board of Pharmacy Rule 1140-
03-.08 in regard to a pharmacy repackaging another pharmacy’s
medications was discussed. The Board concluded that it is currently
a violation for one pharmacy to repackage another pharmacy’s
medications. The Board agreed that the process would be positive
for patient safety, but a rule change is needed to legalize this type
of activity.
quoted from Tennessee Board of Pharmacy June 2013 Newsletter

Tennessee New Statute Regarding Office Use


Statute Amended Regarding Compounding
As stated in Public Chapter 266, TCA 63-10-204(4), the definition
of “compounding” includes the following new language:
(D) For use in a licensed prescribing practitioner’s office for
administration to the prescribing practitioner’s patient or
patients when the product is not commercially available
upon receipt of an order from the prescriber;
(E) For use in a health care facility for administration to
a patient or patients receiving treatment or services
provided by the facility when the product is not commercially
available upon receipt of an order from an
authorized licensed medical practitioner of the facility;
(F) For use by emergency medical services for administration
to a patient or patients receiving services from them
under authorized medical control when the product is
not commercially available upon receipt of an order
from a licensed prescriber authorized to provide medical
control; or
(G) For use by a licensed veterinarian for administration
to their non-human patient or patients or for dispensing
to non-human patients in the course of the practice
of veterinary medicine upon receipt of an order from
a veterinarian when the product is not commercially
available.
In TCA 63-10-204(12), the definition of “dispense” now reads
as follows:
. . . “Dispense” means preparing, packaging, compounding
or labeling for delivery and actual delivery of a prescription
drug, nonprescription drug or device in the course of
professional practice to a patient or the patient’s agent, to
include a licensed health care practitioner or a health
care facility providing services or treatment to the patient
or patients, by or pursuant to the lawful order of a
prescriber . . .
TCA 63-10-216 adds this section as follows:
(a) Prior to initial licensure in this state as a compounding
pharmacy, a pharmacy located outside of this state

must have an inspection by the regulatory or licensing
agency of the state in which the pharmacy practice site
is physically located. Out-of-state pharmacy practice
sites must provide a copy of the most recent inspection
by the regulatory or licensing agency of the state in
which the pharmacy practice site is physically located,
which must have been within the previous twelve (12)
months. Prior to renewal of its license in this state, an
out-of-state pharmacy practice site must provide the
most recent inspection by the regulatory or licensing
agency of the state in which the pharmacy practice site
is physically located or equivalent regulatory entity,
and which must have been within the previous twelve
(12) months. The board of pharmacy shall have the
right to require additional information before issuing or
renewing a pharmacy license to insure compliance with
applicable laws of this state and any rules and policies
of the board.
(b) Any compounding pharmacy having an active Tennessee
license shall notify the board within fourteen (14)
business days of receipt of any order or decision by a
regulatory agency, other than the Tennessee board of
pharmacy, imposing any disciplinary action, including
any warning, on the pharmacy.
(c) Any pharmacies engaged in sterile compounding must
comply with relevant United States Pharmacopeia (USP)
guidelines as adopted by the board by rule or policy.
(d) Any pharmacies engaging in sterile compounding, except
hospital pharmacies compounding for inpatients of
a hospital, shall report on a quarterly basis to the board
the quantity of sterile compounded products dispensed
in a defined time period in accordance with policies
adopted by the board; provided, however, the executive
director of the board may request this information from
a hospital pharmacy for cause and the hospital pharmacy
shall be required to respond in a timely manner as defined
by the executive director of the board.
The Board plans to discuss rules and policies for additional clarification
to the statute in the near future.
In regard to federal compounding regulations, be advised to
continually monitor United States Code 21 353. The current
regulation may be found at the following Web link: www
.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/
PharmacyCompounding/ucm155666.htm.

Quoted from Tennessee Board of Pharmacy June 2013 Newsletter

West Virginia Board of Pharmacy Discusses Compounding v. Manufacturing --Compounding for Office Use--Limited Office Use is Permitted --Invoice


Compounding Versus Manufacturing:
Compounding for Office Use
Last quarter, the Board discussed compounding pursuant to
a prescriber’s order (prescription) versus manufacturing. That
article concluded, in part, “ . . . unless it is for a research, teaching
or other similar situation which is not for sale or dispensing,
pharmacies may compound only for individual prescriptions,
or in anticipation of their regular and routine prescriptiondispensing
needs.” However, during the legislative session,
representatives of ophthalmologists expressed concern about
being able to get certain eye drops prepared for their office
use with their patients during certain routine procedures. They
indicated that the solutions are not available on the market and
must be compounded, and that the current law would require
them to write or call in prescriptions for the patient to pick up
and bring with them to appointments. They suggested that this
would be inconvenient and unnecessarily costly for the patients,
often requiring patients to make a second visit because the doctor
would not know until during the initial examination that the
drops would be needed, requiring the exam to be postponed
until the drops could be prescribed, prepared, and picked up
by the patient. As a result, the Board discussed at the March
Board meeting whether to permit limited compounding done
“for office use,” or whether a prescription is always required.
After some discussion, the Board determined that it is in
the best interest of the patient to permit limited compounding
for office use in West Virginia. Therefore, the Board decided
that it would exercise discretion in enforcement with regard
to compounding for that purpose. The motion passed by the
Board stated that this would extend only to minimal amounts of
compounding necessary to fill an order placed by a prescriber

for use in his or her office in the immediate future. No bulk
compounding is permitted under this exception. Further, in no
event, whether for compounded drugs supplied for office use
or any other transfer of prescription drug stock for office use,
may this be documented as a prescription order. Because the
transfer of the compounded product would be done for a prescriber
to have in supply for general office use, the transaction
must be properly documented by invoice the same as any other
wholesale transaction. Finally, this very limited exception does
not in any way change the analysis that all other compounding
must be done for a prescription, or for a research, teaching,
or other similar situation that is not for sale or dispensing, as
required by law.

quoted from West Virginia Board of Pharmacy June 2013 Newsletter

West Virginia Pharmacy Practice Act Receives Makeover with New Practice Act Entitled The Larry W. Border Pharmacy Practice Act


New Practice Act Entitled ‘The Larry W.
Border Pharmacy Practice Act’
The West Virginia Pharmacy Practice Act received a makeover
during the 2013 Regular Legislative Session. The legislature
passed House Bill 2577 on April 13, 2013, setting an
effective date of July 1, 2013. At the time of this writing, the
bill was among the many pieces of legislation that passed that
have to be painstakingly reviewed by the Governor’s Office
as he decides whether to sign them or not. The West Virginia
Board of Pharmacy has been informed that Governor Earl Ray
Tomblin plans to sign the bill, so it will become law, effective
at the beginning of July. If for some reason the bill does get
vetoed, then you can stop reading here . . . that is, unless you
just love the Newsletter so much that you want to see what the
Board would have had to say about it anyway.


continue reading in West Virginia Board of Pharmacy June 2013 Newsletter

Contaminated Compounded Steroid Infects 13 Floridians By Jennifer Wolack, // June 1, 2013

watch video and read story here

American Pharmacy Association Comments on Senate Bill (Pharmaceutical Compounding Quality and Accountability Act


APhA comments on Senate draft proposal
The Senate Health, Education, Labor, & Pensions (HELP) Committee on May 15 introduced the Pharmaceutical Compounding Quality and Accountability Act (S. 959) following a full committee hearing and comments from stakeholders, such as APhA, on an April 26 draft proposal.
The Senate compounding bill—a manager’s mark, or updated bill, was released May 20—would draw a line between traditional compounders, which would be regulated primarily by state boards of pharmacy, and “compounding manufacturers,” which would be regulated by FDA; compounding manufacturers would be defined as those that make sterile products without or before a prescription and sell those products across state lines. Pharmacies within health systems would remain regulated as traditional compounders. Compounding manufacturers could not be licensed as pharmacies.
Compounding manufacturers would register with FDA, make products under a pharmacist’s oversight and in compliance with Good Manufacturing Practices, and pay an annual establishment fee to defray the cost of FDA oversight such as inspections and a reinspection fee as needed; small businesses would pay reduced fees.
Traditional compounders would be prohibited from compounding marketed FDA-approved drugs not in shortage, variations of marketed FDA-approved drugs unless they fulfill a specific patient need, or products subject to certain Risk Evaluation and Mitigation Strategies unless it is to fulfill a specific patient need and the compounder uses comparable safety controls. The compounding of certain drugs demonstrably difficult to compound, such as complex dosage forms and biologics, could be prohibited through regulatory rulemaking with comments. Wholesale distribution of compounded products would not be permitted. Marketing of compounded drugs could not be false or misleading.
The Senate compounding bill also would encourage communication among FDA and the states as well as among the states themselves. For more information on the bill, visit the HELP Committee website (www.help.senate.gov).
continue reading here