Wednesday, January 1, 2014

American Pharmacy Association: How new compounding, track-and-trace law may affect pharmacists; FDA issues pharmacy compounding draft guidance January 1, 2014

President Barack Obama signed the Drug Quality and Security Act (H.R. 3204) into law on November 27. What are the practical implications for most pharmacists of the new compounding and track-and-trace legislation?
The short answer is that the compounding part of the legislation, which became effective upon enactment, may affect more pharmacists than initially anticipated (see page 56 for more information). The track-and-trace part of the legislation will affect all pharmacists to some extent, according to Michael Ghobrial, PharmD, JD, APhA Associate Director of Health Policy.
Of course, the language in the legislation is not the last word. FDA has to decide how to implement it through the regulatory process. Traditional community pharmacies are “probably” not going to be affected by the compounding part of the law “unless we get more stringent regulation from the FDA,” said Lee Rosebush, PharmD, JD, MBA, MS, Counsel at the BakerHostetler law firm in Washington, DC. “While we got by with 3204, we may not necessarily get by with the regulations proposed by FDA.”

Compounding: Practical impact

Under the new law, traditional pharmacies are still regulated by state boards of pharmacy. Compounding pharmacies are still regulated by state boards of pharmacy, Ghobrial said. But now compounding pharmacies that voluntarily elect to be “outsourcing facilities” are regulated by both state boards of pharmacy and FDA.
“Here’s the big question everybody’s going to be asking: If [registration with FDA] is voluntary, why would you want to have the FDA breathing down your neck? And the answer to that is brilliant,” Ghobrial said. “People will sign up because their product is less likely to be sold if they’re not an FDA-overseen outsourcing facility.”
Traditional pharmacies that do sterile compounding based on specific, individualized prescriptions have no reason to register with FDA, emphasized Rosebush. Pharmacies that are going to supply office use medication, however, have to do the registration. “You’re going to see a business model determination,” Rosebush said. “You’re going to see entities say, ‘Well, is the $15,000 user fee and the cGMP [current Good Manufacturing Practices] compliance worth moving into this new business model?”
Rosebush has “several clients who are large compounding pharmacies,” he said. “I do have some that are willing to register with the FDA and are currently pursuing compliance policies that use cGMPs and USP [U.S. Pharmacopeia] <797> standards. We eagerly await the publication of regulations in this area.” He added, “Some of my clients do not feel that they will have to register with the FDA and are not planning on registering with the FDA.”
continue to read at http://www.pharmacist.com/how-new-compounding-track-and-trace-law-may-affect-pharmacists-fda-issues-pharmacy-compounding-draft

Pharmacies that custom-make drugs are soliciting physician investors in Texas and other states for potentially lucrative deals in which the doctors refer patients to the pharmacy and share in any profits; Executive Director of TSBP Indicates they will investigate such deals

Sunday, November 10, 2013

Ethical questions raised as doctors partner with pharmacies

Pharmacies that custom-make drugs are soliciting physician investors in Texas and other states for potentially lucrative deals in which the doctors refer patients to the pharmacy and share in any profits.
In addition, some compounding pharmacies are asking the doctors to refer patients to a clinical trial to test a pain cream or other compound the pharmacy provides, officials familiar with the proposals said.

State regulators, physician groups in Austin and national experts are aware of the trend and concerned the deals could run afoul of federal and state anti-kickback laws, conflict-of-interest rules and patient-care standards.

The arrangements could give doctors a profit motive to overprescribe certain custom medicines, which can be a patient cost and safety issue. But whether the deals are legal depends on how the arrangements are structured, state officials said.

“There are some serious questions whether this is resulting in unfair billings to the taxpayer” through government coverage programs, such as Medicare and Medicaid, said David Miller, senior vice president and CEO of the International Academy of Compounding Pharmacists, which represents more than 3,600 pharmacists and others in the compounding industry. Those billings can go beyond reimbursements for drugs because patients often receive follow-up care to monitor their health after receiving them.

It’s not known how many doctors are signing up for partnerships with compounding pharmacies because no one compiles such data. Officials with three companies soliciting doctors in Austin didn’t return calls; one official who was reached declined to comment.

Compounding pharmacies play an important role in medicine, mixing drugs that patients can’t get otherwise. But the physician-investor arrangements are coming at a time when a few of the pharmacies are getting unwanted national attention. After 64 patients died last year after receiving a compounded drug, Congress has been mulling legislation that would broaden Food and Drug Administration authority over those pharmacies.

Last Monday, the U.S. Justice Department announced that Johnson & Johnson would pay $2.2 billion to settle investigations that it paid kickbacks to doctors and nursing home pharmacies to promote the use of certain, non-compounded drugs, among other things. It was one of the largest health care fraud settlements in U.S. history, department officials said.

Doctors must disclose

Doctors in Texas are allowed to own or invest in pharmacies, surgical centers and medical equipment, but they have an ethical duty to disclose such ownership to patients when referring them to those services, according to guidance from an ethics board of the Texas Medical Association, a group that represents physicians. The doctors also should give patients a list of alternative facilities, if one exists.

A federal measure, known as the Stark law, puts limits on such physician referrals, and states, such as Texas, forbid kickbacks under such laws as the Texas Solicitation of Patients Act.

Whether the arrangements between doctors and compounding pharmacies are legal is one question, said Gay Dodson, executive director of the Texas State Board of Pharmacy. Whether they are ethical is another, she and others said.

“I would tell them to be careful of what they are doing,” Dodson said. “It could be an illegal practice, and it’s something we would investigate if we got notice of it.”
Genzyme Corp. to Pay $22.28 Million to Resolve False Claims...

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Second Question of the Day January 1, 2014 How many compounding pharmacies or pharmacists will be charged (civil and/or criminal) by the federal goverment in 2014 under the DQSA?


Question of the Day January 1, 2014 How many compounding pharmacies will close their doors in 2014? How many new compounding pharmacies will open their doors in 2014?


New Guidelines Issued on Menopausal Symptom Management CME/CE -Too little evidence supports a benefit of compounded bioidentical hormones, phytoestrogens, herbal remedies, or exercise.

News Author: Ricki Lewis, PhD
CME Author: Laurie Barclay, MD


CME/CE Released: 12/31/2013 ; Valid for credit through 12/31/2014
 Clinical Context
The most common symptoms associated with menopause are vasomotor symptoms, including hot flushes, and vaginal symptoms. Vasomotor symptoms, which occur in approximately 50% to 82% of US women who go through natural menopause, can be especially troubling.
Vasomotor symptoms increase in prevalence during the transition to menopause, with peak frequency approximately 1 year after the last menstrual period. The American College of Obstetricians and Gynecologists (ACOG) updated its evidence-based guidelines for the treatment of vasomotor and vaginal symptoms associated with natural and surgical menopause.

continue to read here

2013 Star Scientific, Inc. 12/20/13

2013 Star Scientific, Inc. 12/20/13

2013 Three L Farm 12/19/13

2013 Three L Farm 12/19/13

FDA Warning Letters

Warning Letters