Thursday, September 26, 2013

Alexander Announces Agreement to Help Prevent Tennessee Families From “Living Through Another Nightmare Like Last Year’s Tragic Meningitis Outbreak” House action possible this week on legislation to clarify oversight of each compounding facility


Wednesday, September 25, 2013Liz Wolgemuth 202-224-8584
***
"The FDA commissioner has warned us that, without fixing oversight, a similar outbreak will happen again, so I have worked hard with my colleagues in the House and Senate to make it clear at every compounding facility who’s on the flagpole—who’s in charge—of overseeing their compounding practices.” – Lamar Alexander
WASHINGTON, Sept. 25— Sen. Lamar Alexander (R-Tenn.), the senior Republican on the U.S. Senate health committee today announced that leaders from the Senate and House committees that oversee health policy have reached an agreement on legislation to help ensure the safety of compounded drugs and to track prescription drugs from the time they’re manufactured to the moment they are picked up at a drugstore. The House of Representatives may take action on the legislation this week, and Alexander said he hopes “the Senate acts promptly on the legislation, because the FDA commissioner has warned us that an outbreak like this will happen again if we don’t clarify oversight.”
Alexander said: “This bill will help prevent Tennessee families from living through another nightmare like last year’s tragic meningitis outbreak, which has killed 16 Tennesseans and sickened so many others. I have worked hard with my colleagues in the House and Senate to make it clear at every compounding facility who’s on the flagpole—who’s in charge—of overseeing their compounding practices.” 
Today’s agreement was announced was by Alexander and Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Tom Harkin (D-Iowa), House Energy and Commerce Chairman Fred Upton (R-Mich.) and Ranking Member Henry Waxman (D-Calif.). The bill clarifies current federal law regarding pharmacy compounding and resolves the patchwork of current federal regulation by applying a uniform standard nationwide.
Further, compounders who wish can register as outsourcing facilities, but those who choose to remain traditional pharmacies will continue to be regulated primarily by state boards of pharmacy, as they are in current law.  Outsourcing facilities would be subject to oversight by the U.S. Food and Drug Administration (FDA) in much the same way as traditional manufacturers are monitored.  FDA will know who these outsourcers are and what they are making, receive adverse event reports about compounded drugs, and have the authority and resources to conduct risk-based inspections.
The legislation will include the Drug Supply Chain Security Act, legislation passed unanimously by the Senate HELPCommittee, to replace today’s patchwork of state prescription-drug tracing laws by creating a new uniform framework for tracking drugs from the manufacturer to the pharmacy. There is currently no system for tracking the drugs that make up some 4 billion prescriptions per year in the United States, which means drugs that are stolen or counterfeit may not be discovered before reaching consumers.
Last November, when the Senate HELP Committee held its first hearing on the deadly meningitis outbreak, Alexander called for a new model of oversight of sterile compounding pharmacies.
recently released report from the nonpartisan Government Accountability Office (GAO) confirmed that legislation is needed to clarify the FDA’s oversight of large-scale drug compounders. The report authors concluded that there are “gaps in oversight” and that “it is essential to have clear roles for FDA and states in regulation and oversight of drug compounding.”

Compromise bill announced on regulating drug compounders


Written by
Walter F. Roche Jr.
The Tennessean

A compromise bill that supporters say gives the U.S. Food and Drug Administration great regulatory control over drug compounders has been announced by congressional leaders from both the House and Senate, but it is unclear whether it has the support of the FDA itself.
The compromise was disclosed late Wednesday in press releases issued by U.S. Sen. Lamar Alexander, R-Tenn., and a bipartisan group of House leaders including U.S. Rep. Henry Waxman, a California Democrat.
The agreement comes a year after the beginning of a fungal meningitis outbreak that took the lives of 16 patients treated in Tennessee and 64 nationwide. The deadly outbreak has been blamed on a Massachusetts drug compounding company that shipped fungus-tainted spinal steroids to health-care providers in 20 states.
Industry officials said the compromise had been worked out over the weekend, but expressed concern that the FDA had last-minute objections.
Erica Jefferson, FDA spokeswoman, said she could not immediately comment on the matter. Actual copies of the legislation were not immediately available.
“This bill will prevent Tennessee families from living through another nightmare like last year’s tragic meningitis outbreak,” Alexander said in a prepared statement.
The congressional proposal has drawn criticism from advocacy groups like Washington, D.C.-based Public Citizen. Dr. Michael Carome, who heads the group, said both the House and Senate versions of the bill authorize a new category of drug manufacturers that will face less scrutiny than those now licensed by the FDA. He argues that the FDA already has the authority to regulate large drug compounders but has failed to do so.
Carome said Wednesday that he had yet to see the actual legislation and repeated his concerns.

New Federal Compounding Legislation Bill Will Be Called Drug Quality and Security Act,


MORE CONFIRMATION!! U.S. congressional panels agree on bill to regulate drug compounding Source: Reuters - Thu, 26 Sep 2013 12:05 AM Author: Reuters


Updates with details, background)
WASHINGTON, Sept 25 (Reuters) - U.S. House of Representatives and Senate committees have agreed on legislation that would give the Food and Drug Administration greater authority to regulate companies that compound sterile drugs and ship them across state lines.
The legislation would also create a national set of standards to track pharmaceuticals through the distribution chain to help thwart the introduction of fake medication into the drug supply.
The bill, called the Drug Quality and Security Act, comes in response to a deadly outbreak last year of fungal meningitis that killed more than 50 people and was traced to a tainted steroid sold by the New England Compounding Center in Framingham, Massachusetts.
The legislation is expect to pass smoothly and quickly through the full House and Senate.
Traditionally, pharmacists who compound medication mix tailored doses for individual patients in response to specific prescriptions. Over the last decade the practice has mushroomed, with some pharmacies selling thousands of doses of regularly used mixtures without prescriptions for physicians to keep for future use.
The legislation would draw a distinction between traditional compounding pharmacies and those such as NECC which ship sterile products across state lines. These larger organizations, to be known as "outsourcing facilities," would be regulated by the FDA but be exempt from the full spectrum of regulations that apply to traditional pharmaceutical companies.
Traditional compounding pharmacies would continue to be regulated by state boards of pharmacy.
Previous attempts to create national standards to track and trace drugs have foundered amid complaints from companies that they would be too costly to implement.
But concerns over counterfeit drugs have been growing. Last year, fake vials of Roche Holding AG's cancer drug Avastin appeared in the United States from Britain where it was purchased from a Turkish wholesaler.
The World Health Organization estimates that less than 1 percent of medicines available in the developed world are likely to be counterfeit. Globally, that number is around 10 percent.
In the United States, dozens of states have some type of regulation designed to track a drug's pedigree, but the rules are inconsistent. The bill is designed to resolve the current patchwork of federal regulation by applying a uniform standard nationwide. (Reporting by Toni Clarke; Editing by Stacey Joyce and Eric Beech)

quoted from here

BREAKING NEWS!! Lawmakers strike agreement on compounding pharmacy regulation By Elise Viebeck - 09/25/13 10:00 PM ET


Health policy leaders in the House and Senate announced an agreement on legislation to strengthen regulation of non-traditional compounding pharmacies, which have been tied to several deadly outbreaks in the last year. 

Lawmakers said the new bill would apply uniform national standards to pharmacy compounding while enacting a track-and-trace system to ensure drugs are safe throughout the supply chain. 

Currently, a patchwork of state and federal regulations complicates oversight of drug compounders, who either customize medications on a prescription-by-prescription basis or produce drugs in large quantities like a manufacturer. 
Under the Drug Quality and Security Act announced Wednesday, traditional compounders would largely remain under the jurisdiction of state boards of pharmacy while larger operations would be regulated by the Food and Drug Administration (FDA). 

Lawmakers had urged for a clarification of the FDA's duties following a multistate outbreak of fungal meningitis that has killed more than 60 people since last year. 

The deaths were caused by tainted steroid injections produced by the New England Compounding Center, a now-shuttered company whose safety violations were never fully penalized by regulators. 

The outbreak prompted a series of hearings in both the House and Senate and a vigorous debate over whether the FDA deserved new powers to oversee compounding. 

Republican and Democratic leaders praised the final agreement as a victory for patients and victims' families and a move against further tragedy. 

"This legislation is a major stride toward the goal of ensuring the quality and safety of the medicines Americans rely upon every day," said House Energy and Commerce Committee Ranking Member Henry A. Waxman (D-Calif.) in a statement. 


Read more: http://thehill.com/blogs/healthwatch/public-global-health/324755-lawmakers-strike-agreement-on-compounding-pharmacy-regulation#ixzz2fyLWvukw 
Follow us: @thehill on Twitter | TheHill on Facebook

Interesting Fact--Compounded drugs make up about four billion prescriptions each year in the United States.


Bill Would Toughen Compounding Pharmacy Oversight September 26, 2013 (AP) By STEVE LeBLANC Associated Press


The Food and Drug Administration would have greater oversight over large volume compounding pharmacies like the Massachusetts company that triggered a deadly meningitis outbreak, under federal legislation winning bipartisan support.


Iowa Sen. Tom Harkin, the Democratic chairman of the Committee on Health, Education, Labor, and Pensions, said Wednesday that the bill calls for an "unprecedented tracing system that will track prescription drugs from manufacturing to distribution."
continue to read here

Wednesday, September 25, 2013

WASHINGTON SECRETS Support grows for letting FDA police drug compounding firms BY PAUL BEDARD | SEPTEMBER 25, 2013 AT 3:48 PM


With Congress poised to give the Food and Drug Administration (FDA) expanded powers over drugs and drugmakers like the one linked to a deadly outbreak of meningitis last year, the public --- even Republicans --- are clamoring for new regulations.
A new poll from a pro-regulation group found that 73 percent of Republicans, 83 percent of Democrats and 70 percent of independents want compounding pharmacies to be regulated by the FDA, which they aren’t today.
Overall, the poll from the Working Group on Pharmaceutical Safety found that 87 percent want their doctor to tell them when drugs prescribed are non-FDA approved, and 77 percent are concerned that the FDA isn't doing its job.
The congressional effort comes a year after drugs linked to a specialty Massachusetts drug compounder, New England Compounding Center (NECC), caused a deadly meningitis outbreak. Sixty-four people died.
Tommy Thompson, a former secretary of the Department of Health and Human Services, heads the Working Group and said the poll indicates the support Congress has for expanding FDA’s regulatory authority over the companies.
“The NECC tragedy and recent troubling findings following inspections of compounding pharmacies underscore the need for the strongest possible legislation that meets the simple and straightforward expectations of voters,” said Thompson.
Paul Bedard, the Washington Examiner's "Washington Secrets" columnist, can be contacted atpbedard@washingtonexaminer.com.

Pressure Mounts On Drug Security Bill As Stakeholders Await Bicameral Agreement



Two key stakeholders are pressing for action on drug distribution security legislation that has been tied to a drug compounding bill and is part of overarching House and Senate negotiations.

Can anyone from the Texas Board of Pharmacy Respond to this Readers Question about NuVision?


Anonymous said...
The Services Provided section of NuVision's Texas Pharmacy License says that the pharmacy does NOT do low, medium, or high risk sterile compounding, just non-sterile compounding. This information is obviously incorrect, or falsified. NuVision does sterile compounding openly, and on a large scale. It is ironic that NuVision continues to refuse FDA requests to recall all of its sterile products, when according to its Texas Pharmacy license, NuVision doesn't even compound any sterile products. Why does the TSBP allow NuVision to continue to flagrantly violate the published provisions of its state pharmacy license?

The Article in More Magazine that everyone has been waiting to read--THE HORMONE HOAX THOUSANDS FALL FOR--An the magazine hit newsstands yesterday

read it here



Note: On the TSBP pharmacies I just reported on, note that I also checked the downloaded tables which are updated every Tuesday for more recent information that might not have been reported on the TSBP website.


Here is what TSBP Says About Pharmedium Services, LLC in Sugar Land, TX--No Disciplinary Orders--Who is right TSBP or FDA? Who did a better job of inspecting?


exas Pharmacy License # 22931

PHARMEDIUM SERVICES, LLC

License Information

License Status
Active
License #
22931
Expiration Date
11/30/2013
Date License Issued
11/19/2003

Address

12620 W AIRPORT BLDV SUITE 130
SUGAR LAND, TX  77478
County
FORT BEND
Phone
(281) 491-1900

Pharmacy Details

Prior Disciplinary Orders*   
No
Class of Pharmacy
Community
Type of Ownership
Other
Type of Pharmacy
Community Independent
# of Hospital beds
0
* Information relating to disciplinary orders is current as of (30 days prior to this date).
A written request for information regarding prior disciplinary orders may be submitted to the office of the Texas State Board of Pharmacy. Disciplinary orders entered pursuant to Chapter 564 of the Texas Pharmacy Act are confidential and not subject to disclosure.

Employment Information

Pharmacist in Charge
UPADHYAY, SHETAL MANISH

Pharmacy Profile ¥

Accessible to disabled persons?
No
Participates in the Texas Medicaid program?
No
Participates in the Texas Kids Insurance Program (SKIP)?
No
Dispenses prescriptions in response to an Internet order?
No
Delivers prescription to a patient in this state?
No
Translating services
¥ Please note: The data regarding accessibility, translating services, and insurance participation is self-reported by the license holder and no warranty regarding the information is created. Therefore, neither the State of Texas nor the licensing agency accept any legal liability or responsibility or may be held liable or responsible for the accuracy, completeness, timeliness, or usefulness of this information. Should you have any concern as to the accuracy of the data in this system, please contact the license holder or facility for clarification.

Services Provided

No
Nuclear
No
Out-Patient Sterile Products
No
Out-Patient/Discharge Prescriptions
No
Mail Service
No
Long Term Care
No
Class D (Expanded Formulary)
No
Class D (Alternative Visit Schedule)
Yes
Compounding Sterile-Risk Level Low
Yes
Compounding Sterile-Risk Level Med
No
Compounding Sterile-Risk Level High
No
Compounding Non-Sterile
No
Other Service
Texas Pharmacist Employment information

Here is what TSBP Says About OakDell Pharmacy--No Disciplinary Orders and No indication it even does sterile compounding? So who is right TSBP or FDA? Maybe the better question is who did a better job inspecting TSBP or the FDA


Texas Pharmacy License # 125

OAKDELL PHARMACY

License Information

License Status
Active
License #
125
Expiration Date
11/30/2013
Date License Issued
Unknown

Address

7220 LOUIS PASTEUR SUITE 176
SAN ANTONIO, TX  78229-4535
County
BEXAR
Phone
(210) 614-6200

Pharmacy Details

Prior Disciplinary Orders*   
No
Class of Pharmacy
Community
Type of Ownership
Corporation
Type of Pharmacy
Community Multi
# of Hospital beds
0
* Information relating to disciplinary orders is current as of (30 days prior to this date).
A written request for information regarding prior disciplinary orders may be submitted to the office of the Texas State Board of Pharmacy. Disciplinary orders entered pursuant to Chapter 564 of the Texas Pharmacy Act are confidential and not subject to disclosure.

Employment Information

Pharmacist in Charge
SUMNERS, SCOTT

Pharmacy Profile ¥

Accessible to disabled persons?
Yes
Participates in the Texas Medicaid program?
Yes
Participates in the Texas Kids Insurance Program (SKIP)?
Yes
Dispenses prescriptions in response to an Internet order?
No
Delivers prescription to a patient in this state?
No
Translating services
Spanish
¥ Please note: The data regarding accessibility, translating services, and insurance participation is self-reported by the license holder and no warranty regarding the information is created. Therefore, neither the State of Texas nor the licensing agency accept any legal liability or responsibility or may be held liable or responsible for the accuracy, completeness, timeliness, or usefulness of this information. Should you have any concern as to the accuracy of the data in this system, please contact the license holder or facility for clarification.

Services Provided

No
Nuclear
No
Out-Patient Sterile Products
No
Out-Patient/Discharge Prescriptions
No
Mail Service
No
Long Term Care
No
Class D (Expanded Formulary)
No
Class D (Alternative Visit Schedule)
Yes
Compounding Sterile-Risk Level Low
Yes
Compounding Sterile-Risk Level Med
Yes
Compounding Sterile-Risk Level High
No
Compounding Non-Sterile
No
Other Service

Here is what the Texas State Board of Pharmacy (TSBP) says about IV Solutions of Lubbock--It Shows Disciplinary Action!!! It says: IV Solutions of Lubbock, Pharmacy License No. 17088, Lubbock, TX. Alleged violation: dispensing error. Agreed Board Order accepted by licensee and entered by the Board on 05-08-12: license reprimanded; fined $1500; and must develop and implement a Continuous Quality Improvement Program (to include peer review) for purposes of preventing and handling dispensing errors. Language of Agreed Order Copied and Pasted At Bottom.


IV SOLUTIONS OF LUBBOCK

License Information

License Status
Active
License #
17088
Expiration Date
04/30/2014
Date License Issued
04/12/1996

Address

3706 A 20TH STREET
LUBBOCK, TX  79410
County
LUBBOCK
Phone
(806) 791-4663

Pharmacy Details

Prior Disciplinary Orders*   
Yes

View Order Details Below:
Class of Pharmacy
Community
Type of Ownership
Corporation
Type of Pharmacy
Other
# of Hospital beds
0
* Information relating to disciplinary orders is current as of (30 days prior to this date).
A written request for information regarding prior disciplinary orders may be submitted to the office of the Texas State Board of Pharmacy. Disciplinary orders entered pursuant to Chapter 564 of the Texas Pharmacy Act are confidential and not subject to disclosure.

Employment Information

Pharmacist in Charge
HEATON, JESSIE BRENT

Pharmacy Profile ¥

Accessible to disabled persons?
Yes
Participates in the Texas Medicaid program?
Yes
Participates in the Texas Kids Insurance Program (SKIP)?
No
Dispenses prescriptions in response to an Internet order?
No
Delivers prescription to a patient in this state?
No
Translating services
Spanish
Telecomm. for the deaf (TDD)
Other
¥ Please note: The data regarding accessibility, translating services, and insurance participation is self-reported by the license holder and no warranty regarding the information is created. Therefore, neither the State of Texas nor the licensing agency accept any legal liability or responsibility or may be held liable or responsible for the accuracy, completeness, timeliness, or usefulness of this information. Should you have any concern as to the accuracy of the data in this system, please contact the license holder or facility for clarification.

Services Provided

No
Nuclear
Yes
Out-Patient Sterile Products
No
Out-Patient/Discharge Prescriptions
Yes
Mail Service
No
Long Term Care
No
Class D (Expanded Formulary)
No
Class D (Alternative Visit Schedule)
Yes
Compounding Sterile-Risk Level Low
Yes
Compounding Sterile-Risk Level Med
No
Compounding Sterile-Risk Level High
No
Compounding Non-Sterile
No

AGREED BOARD ORDER #J-11-012 
RE:  IN THE MATTER OF 
IV SOLUTIONS OF LUBBOCK 
(PHARMACY LICENSE #17088) 
BEFORE THE TEXAS STATE 
BOARD OF PHARMACY 
On this  day  came on to  be considered by the Texas  State Board of Pharmacy the 
matter of pharmacy license  number  17088  issued  to  IV  Solutions  of Lubbock,  3706  A 
20th Street, Lubbock, Texas 79410. 
By letter dated July 29,  2011, the Texas State Board of Pharmacy gave preliminary 
notice to  IV  Solutions of Lubbock of its  intent to  take disciplinary action with respect to 
pharmacy  license  number  17088  issued  to  IV  Solutions  of Lubbock.  This  action  was 
taken as a result of an investigation which produced evidence indicating that IV Solutions 
of Lubbock may have violated: 
Section  565.001(a)(l),  (2)  and  (12);  and  Section  565.002(a)(3)  of  the 
Texas Pharmacy Act, TEx. Occ. CoDE ANN. Subtitle J (2005); and 
Section  281.7(a)(l2)  and  (13);  Section  291.26(c)(I)(B)(vii);  Section 
291.31 (I), (14) and (15); Section 291.32(a)(2)(H); Section 291.32( c )(I )(E) 
and (F);  Section 291.32(c)(2)(B)  and (D);  and Section 295.3  of the Texas 
Pharmacy Board Rules, 22 TEx. ADMIN. CODE (2007), in that,  allegedly: 
COUNT 
On  or  about  March  20,  2007,  Robby  Don  Timberlake,  while  acting  as  an 
employee  (pharmacist-in-charge)  of  IV  Solutions  of  Lubbock,  3706  A  20'h  Street, 
Lubbock,  Texas  79410,  dispensed  to  patient  J.K.  a  compounded  preparation  of 
colistimethate 75mg  per  3m!  0.225% NaCI  in  plastic  ampules with  directions  to  "inhale 
the  contents of I  ampule  (75mg)  via  eFlow twice  daily  as  directed."  A  quantity of 60 
plastic  ampules was supplied to  patient J.K.  The  prescription that was  issued to  J.K.,  a 
cystic fibrosis patient, called for colistimethate 150mg/6ml in sterile water with directions 
to  "add 3m!  (75mg)  of colistimethate  and  lml of Bronchosaline  to  eFlow  and  nebulize 
twice  daily as  directed."  The prescription indicated a quantity of 30.  On or about April 
26,  2007,  patient  J.K.  began  therapy  as  instructed  by  the  prescription's  label.  The 
prescription was assigned prescription number 20008265. Agreed Board Order #J-11-0 12 
IV Solutions of Lubbock 
Pagel 
An  informal  conference  was  held  in  the  office  of the  Texas  State  Board  of 
Pharmacy  on  September  7,  2011,  with  George  Carlisle  Birdsong,  R.Ph.,  Corporate 
President of Max or National Pharmacy Services,  on behalf of IV  Solutions of Lubbock, 
and  Hector De  Leon,  Legal  Counsel  for  IV  Solutions  of Lubbock,  in  attendance.  The 
informal  conference  was  heard  by a Board panel  comprised  of:  Jeaune  D.  Waggener, 
R.Ph.,  Board  Member;  Gay  Dodson,  R.Ph.,  Executive  Director/Secretary;  and  Carol 
Fisher,  R.Ph.,  M.P.A.,  Director  of  Enforcement;  with  Kerstin  E.  Arnold,  General 
Counsel.  Linda K. Townsend, Staff Attorney, was  also in attendance. 
At the  aforementioned  conference,  Hector De Leon stated  he was present for  and 
on behalf ofiV Solutions of Lubbock. 
Subsequent to the informal conference, IV Solutions of Lubbock retained Julian L. 
Rivera as its Legal Counsel. 
By George Carlisle Birdsong's  appearance  at  the  informal  conference,  and by his 
signature  and  Julian  L.  Rivera's signature on this  Order,  George Carlisle Birdsong and 
Julian  L.  Rivera  agree  that  the  Texas  State Board  of Pharmacy  has jurisdiction in  this 
matter,  and  do  hereby  waive  the  right  to  notice  of hearing,  to  a  formal  administrative 
hearing, and to judicial review of this Order. 
After discussion  of the matters  previously outlined  in this  Order,  and subsequent 
communications,  George  Carlisle  Birdsong  and  Julian  L.  Rivera,  on  behalf  of  IV 
Solutions of Lubbock,  agreed  to  the  entry of an Order disposing of the  need for  further 
disciplinary  action  in  this  matter.  By  their  signatures  on  this  Order,  George  Carlisle 
Birdsong and Julian L.  Rivera neither admit nor deny the truth of the  matters previously 
set out in this Order with respect to the above alleged violations. Agreed Board Order #J-11-0 12 
IV Solutions of Lubbock 
Page3 
Should  this  Order  not  be  accepted  by  the  Board,  it  is  agreed  that  neither  the 
presentation of the Order to the Board nor the Board's consideration of the Order, will be 
deemed to  have unfairly or illegally prejudiced the Board or its individual members and, 
therefore,  will  not be  grounds for  precluding the  Board or any individual member of the 
Board  from  further  participation  in  proceedings  related  to  the  matters  set  forth  in  the 
Order. 
George  Carlisle  Birdsong  and  Julian  L.  Rivera,  on  behalf of IV  Solutions  of 
Lubbock,  understand that any failure to  comply with the terms of this Order is a basis for 
discipline under the Texas Pharmacy Act. 
At  the  conclusion  of  the  aforementioned  conference,  and  subsequent 
communications,  it  was  agreed  among  the  parties  that  IV  Solutions  of Lubbock  shall 
comply with the terms and conditions set forth in the ORDER OF THE BOARD below. 
ORDER OF THE BOARD 
THEREFORE,  PREMISES  CONSIDERED,  the  Texas  State  Board  of Pharmacy 
(hereinafter  referred  to  as  "BOARD")  does  hereby  ORDER  that  pharmacy  license 
number 17088 held by IV Solutions of Lubbock (hereinafter referred to  as  "Respondent") 
shall be, and such license is hereby reprimanded. 
It  is  further  ORDERED  that  Respondent  shall  develop  and  implement  policies 
and  procedures  for  a  Continuous  Quality  Improvement  Program  for  purposes  of 
preventing  and  handling  dispensing  errors.  The  Continuous  Quality  Improvement 
Program shall include pharmacist peer review in compliance with gu