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Editorial: What is Compounding Pharmacy, Part VIII: Patient-centered

A patient is one that is receiving medical care; a patient can be human or veterinary; a patient may be an infant, child, young adult, adult, or elderly adult; a patient may be slightly ill, ill, or critically ill; a patient may be of any race or creed; a patient may be rich or poor; a patient may be friendly, passive, or aggressive; a patient may be tall, short, thin, or heavy; patients come in many different "forms" and from many different "situations."

A compounding pharmacist addresses the needs of all patients upon receipt of a prescription or medication order from a qualified-licensed healthcare practitioner. The relationship has been in effect from the early days of the shaman, medicine man, apothecary, druggist, and, today, the pharmacist.

But�what happens when another entity is inserted into the triad relationship of the patient-physician-pharmacist with potentially devastating consequences? Well�it is happening with the Pharmacy Benefit Managers (PBMs). These entities evidently feel that they are so knowledgeable, learned, perfect, wise, enlightened, and erudite that they are setting themselves up as the "Masters of the Universe" when it comes to what patients are allowed to receive payment for in the way of compounded medications. In other words, the patients cannot use the money they have paid in for years to have their compounded medications paid for! The PBMs deny this and explain that the patient is not deprived of their prescriptions and that they have the option of paying for it themselves (and the PBMs keep the money). However, doesn't the patient pay premiums over the years to be able to receive what they have paid for when the time of need comes?

It seems the greed (See the first news story below!) of some of these entities has reached an entirely new low with many misrepresentations and distortions that are being spread to try to justify their actions. Countless lives are improved every single day by physicians and patients using compounded medications. It is hard to imagine modern health care without compounded preparations! To remove patient access to an entire class of medications (compounded) they have been and are paying for is irresponsible and possibly criminal.

Express Scripts CEO Paz's Pay Rose 50 Percent in 2012
George Paz, president, chairman, and CEO of Express Scripts, received a total compensation package of nearly $12.8 million in 2012, up 50% from 2011. Paz and the other named executives did not receive the non-equity bonus in 2011 because the company didn't hit the bonus plan's targets for earnings per share. Several other executives received stock bonuses tied to the closing of Express Scripts' $29 billion acquisition of Medco Health Solutions in April 2012.

Other top Express Scripts executives' 2012 compensation was as follows:

• Executive Vice President and Chief Financial Officer Jeffrey Hall received $5.2 million in total compensation, up 79% from 2011
• Executive Vice President, Sales and Marketing Ed Ignaczak received $4.4 million in total compensation, up 86% from 2011
• Executive Vice President and Chief Operating Officer Patrick McNamee received $4.4 million in total compensation, up 85% from 2011
• Executive Vice President and General Counsel Keith Ebling received $3.8 million, up 74% from 2011

PBMs to Limit Coverage for Compounded Medications
Due to increased drug costs, PBMs, such as Express Scripts, Catamaran, etc., are making moves to restrict their coverage for active ingredients used in compounding. They propose to not pay for up to 1,000 different ingredients used in compounding medications for individual patients. This article presents some aspects and issues they are raising about compounding.
http://formularyjournal.modernmedicine.com/formulary-journal/news/compounded-ingredient-costs-pbms-take-action

KV Lawsuit Involving MAKENA Settled
The years-long fight between K-V Pharmaceutical Company (Lumara Health Inc.) and the FDA involving KV's MAKENA (hydroxyprogesterone caproate) Injection, 250 mg/mL, has ended. Just before the Independence Day holiday, KV and the FDA filed a Joint Stipulation of Dismissal With Prejudice with the U.S. District Court for the District of Columbia to dismiss the litigation. The case is now over, but we are all left hanging as to what (if anything) KV got out of a deal to settle the case.
http://www.fdalawblog.net/fda_law_blog_hyman_phelps/2014/07/kv-lawsuit-involving-makena-and-compounded-17p-concludes-in-sopranos-style.html

France to Use Avastin and Not Lucentis
In order to cut healthcare costs, the French government plans to authorize the use of Avastin as an alternative eye disease treatment to the much pricier Lucentis. The government announced that it has introduced an amendment to its social security budget bill that would allow doctors to use Avastin as a treatment for age-related macular degeneration. The use of the drug, which costs 30 times less than Lucentis, could bring the state annual savings of at least 200 million euros ($273 million).
http://www.reuters.com/article/2014/07/02/us-france-roche-idUSKBN0F70SI20140702

Over 99% of Alzheimer's Drugs Not Effective in Tests
Between the years of 2002-2012, the failure rate for drugs developed to treat Alzheimer's disease was an astonishing 99.6%, according to a study released by the Cleveland Clinic Lou Ruvo Center for Brain Health. The analysis showed 244 drugs failed and only one was effective; this in the first-ever study of conducted clinical trials for a disease that is expected to leave millions of baby boomers with dementia in the next few decades. According to the study author, there are now only about 80 drugs being tested. Drugs which have previously been approved include Aricept, Exelon, Razadyne, and Cognex.
http://www.reviewjournal.com/life/health/alzheimer-s-drugs-not-working-according-ruvo-center-study

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�that the USGA Senior Open is currently being held at Oak Tree National, in Edmond, Oklahoma where the International Journal of Pharmaceutical Compounding is located?

If you have never had the opportunity of visiting Edmond, Oklahoma, why not take a look at one of over 35 golf courses (some of which have 36 and 54 holes) where the Open is held and located in the greater Edmond/Oklahoma City area?

Say, big boy,
To go thru life,
How'd you like,
A whiskered wife?
     Burma Shave

We are pleased to announce the accreditation of the following pharmacies:

Eldon Drug Company, Eldon, Missouri; Miranda Henley, PharmD, henley.miranda@yahoo.com. Initial Accreditation for Sterile & Nonsterile Compounding

Rood & Riddle Veterinary Pharmacy, Lexington, Kentucky; Teal Reilly, RPh, treilly@rrvp.com. Re-Accreditation for Sterile & Nonsterile Compounding

Compound Care Plus, Loxley, Alabama; Ashley Hammond, RPh, ahammond@compoundcare.com. Re-Accreditation for Nonsterile Compounding