Editorial: Another Great Idea Gone Bad

Talk about confusion! Every time I turn on my computer, read the newspaper, or read a pharmacy journal, I see something on Medicare Part D. Patients don't understand it, are confused, and even mad. Pharmacists don't all understand it, and those who do are upset. However, it seems that PBMs and the pharmaceutical industry are excited about it.

I'm afraid that what has happened to Medicare Part D is the same thing that happened to HIPAA. HIPAA was enacted by Congress and designed for a very simple and reasonable purpose; to make each person's insurance coverage simpler and easy to move around and work with. HOWEVER, the government bureaucrats got involved, not with making the original law, but with its implementation. Here is where the problem starts. During the implementation phase, many new regulations are put in place; many of which were never envisioned in the original law. It seems that each agency or department is intent on getting as much power and position as possible, so these regulations are put in place to guarantee their own survival and growth. However, what we end up with is a much more detailed and problematic situation that is far more difficult to manage than was originally intended.

Medicare Part D had good intentions. However, it's implementation and the impact of PBMs, third-party providers, and other entities in wanting to get their "share of the pie" results in someone getting cut out or operating at a loss - that someone is pharmacy. The portion of the Medicare dollar that goes to pharmacists is going to be less than just a few pennies; where does the rest of it go? The pharmaceutical manufacturers and their relationships with PBMs guarantee their financial success in this system because they control their own prices. However, pharmacists do not have the "clout" that the multi-billion dollar pharmaceutical industry has so we tend to get left behind. Why not just eliminate the PBMs, third-party providers, and others that do not contribute to health care but simply take a cut of the pie for "managing" (another word for profiteering) and have pharmacists and/or patients simply dispense prescriptions at their cost plus a "reasonable" fee. By eliminating all the "middlemen," there will be less costs involved and the government will save a lot of money. Pharmaceutical manufacturers will need to market to physicians and pharmacists rather than to PBMs, etc. There would be more competition between the drug companies that may lead to better pricing, as physicians and pharmacists could select less expensive therapies and drugs. Bottom line, a simpler system for patients and all involved.

In a way, all this is similar to what has happened to many other government agencies over the years. The U.S. Food and Drug Administration (FDA) has expanded it's "reach" beyond what Congress had originally intended; nowhere in the original 1938 law was pharmacy compounding mentioned, but the FDA has become involved. We now have Medicare Part D, expanded and implemented beyond what was originally intended, that is going to put a lot of pharmacies and pharmacists out of business. In my opinion, the leaders in Washington need to prune all the government agencies back to their original function and eliminate much of the uncontrolled growth that has occurred with little accountability.

Loyd V. Allen, Jr., Ph.D., R.Ph
Editor-in-Chief

The twelfth electronic quick click reference tool was added to CompoundingToday.com this week. This is an exceptionally practical tool for your sterile compounding needs. It provides: 1) information on which disinfectant agent is best for the type of surface or equipment in your clean room; 2) the main characteristics and applications of the disinfectant; and 3) the main brand names of disinfectants used in clean rooms. Get access to this tool and 11 others when you join www.CompoundingToday.com!

Hundreds of emails have been sent this week over IJPC's CNL. Here are some of the topics discussed:

• A source for Ronidazole and a preparation of doses for cats
• Stability data for Lantus insulin used for cats
• Translating an 1800's formula for a historian
• Medicare Part D
• Mouth ulcer treatments
• Magnesium glycinate sources

There are now 336 SOPs on CompoundingToday.com. These two were added this week.

• SOP 1.014 - Security of the Pharmacy
• SOP 1.080 - Chemical Abbreviations/Acronyms

This Regulatory Update has been provided by the International Academy of Compounding Pharmacists. For more information, www.iacprx.org.

Avastin/Levulan Inquiries by Clinical Advisors LLC
IACP and a number of compounding pharmacies recently received letters from a Casey Degen of Clinical Advisors LLC in New York. The letter was written in an ambiguous and elusive format that aroused some concern about the motivation behind the letters. Visit IACP's website for recommendations on how to responding to the letter and participating in the requested consultation. For more information, http://www.iacprx.org/eLinks/12_13_05.html

EPS® Steri-Dropper^TM Bottles

EPS®, Inc. is pleased to announce our line of Steri-Dropper^TM bottles. It's yet another enhancement to our extensive array of bottles and containers.

Steri-Dropper was designed for the extemporaneous packaging of sterile ophthalmic solutions. It consists of 3, 7 and 15 ml polyethylene vials, manufactured from a special zinc stearate-free resin. This special plastic minimizes the risk of particulate forming in solution with certain ophthalmic preparations.

We package the bottles, tips and caps in blisters of 2's rather than 12's or 20's so that you can just prepare whatever you need. You don't need to expose or use 12 or 20 bottles when you only need to make a couple of solutions!

For samples, to order or for more information, please contact us at:
www.medi-dose.com or Email: info@medidose.com

Speed Your Mixing
Increase the speed of mixing liquids of different viscosities by doing the following:

1. First, place the liquid with the lowest viscosity in the container.
2. Next, add the liquid with the next lowest viscosity while mixing (either manually or on a magnetic mixer with a stir bar).
3. Add the liquids in order of increasing viscosity while mixing.

This method generally results in rapid and complete mixing. If liquids with high viscosities are placed in a container first, it takes longer to sweep them into the bulk of the remaining liquid as the viscous liquid tends to lag behind along the edges of the container.