As we conclude this series, a number of questions have been posed for consideration and are presented here.

• What are your thoughts on a national standard for certain widely used drug concentrations that are compounded?
  
  
• Who decides on which drugs will be included?
  
  
• Who decides on which concentration will be selected?
  
  
• Will alternative concentrations be okay?
  
  
• Does this have to be a national standard or can it be a state or regional standard?
  
  
• Will the standard be applied across the board to both hospital and community/chain pharmacies?
  
  
• Will the standard be used in hospitals for both inpatient as well as outpatient prescriptions?
  
  
• Will the standard require only the concentration and be open for the vehicle(s) used?
  
  
• Since there may be different stability issues with different concentrations, will the standard concentration consider that?
  
  
• Will there be any relationship between commercially manufactured product strengths and standardized concentrations of compounded preparations?
  
  
• Will this be limited to single-drug entities or also include drug combinations?
  
  
• Is it feasible to implement only one or two examples at a time in place of an overhaul of the system?
  
  
• What is the most feasible method to inform and educate all involved?

In summary, it is apparent that there are safety, personnel, and economic issues involved that can benefit both the patient(s) and the pharmacies. This issue must be thoroughly vetted to eliminate any unintended consequences and be of benefit in health care.

Loyd V. Allen, Jr., PhD, RPh
Editor-in-Chief
International Journal of Pharmaceutical Compounding
Remington: The Science and Practice of Pharmacy Twenty-second edition

News

Secret Profit-making System Drug Middlemen Use to Make Millions
As an Iowa pharmacist compared a newspaper article with his own records, he saw that for a bottle of generic antipsychotic prescription, CVS had billed Wapello County $198.22. But his pharmacy was reimbursed just $5.73. His question was why was CVS charging almost $200 for a bottle of medication that it told the pharmacy was worth less than $6? And what was the company doing with the other $192.49?

The pharmacist had stumbled across what's known as spread pricing, where companies like CVS mark up—sometimes dramatically—the difference between the amount they reimburse pharmacies for a drug and the amount they charge their clients. It's where pharmacy benefit managers (PBMs) like CVS make a part of their profit. But he didn't think the spread could be thousands of percent.

In an analysis of pharmacy and middleman markups in Medicaid plans around the country, Bloomberg found big spreads on dozens of drugs, and evidence that the spreads are growing. For many widely used generic drugs, state insurance plans are collectively paying millions of dollars in fees to private companies.
https://www.bloomberg.com/graphics/2018-drug-spread-pricing/

Over $10 Million Fraudulently Taken from State Pharmacy Benefit Plan in "Kickback Scheme"
The State Attorney General's office announced it is suing a Florida-based pharmacy and a dozen current and retired state government employees—claiming they engaged in a "kickback pyramid scheme" in 2014 and 2015 to defraud the state's taxpayer-funded Pharmacy Benefit Plan out of $10.9 million by filing "false claims" for extremely expensive mixtures of drugs known as "compounded medicines."

The suit alleges that Assured Rx, which produces and distributes such compounded medicines on a large scale, received $10,911,051 from the state's prescription coverage plan for prescriptions of its medications that were obtained by participants in the alleged scheme.

Assured Rx paid $2,655,958 of that sum in kickbacks to a retired state Department of Correction employee and his former wife, along with a Florida limited liability company that they formed—called NLM LLC—through which they allegedly funneled part of what they received from Assured Rx to other state employees or retirees, whom they recruited into the scheme, the lawsuit says.
http://www.courant.com/politics/hc-pol-ag-lawsuit-compund-drugs-20180910-story.html

Did You Know ...

�that "Life is what happens while you are making other plans!"?

Tip of the Week

We have heard it all our lives, "You need to stop and smell the roses." This begins to mean more as one gets older and does more reflective thinking. There are things that we could have done differently, and things we didn't do that we should have done. Nevertheless, many of the "roses" are still there, and we can still enjoy them.

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Looking Back

Does your husband misbehave,
Grunt and grumble,
Rant and rave?
Shoot the brute some
     Burma Shave