Senate Bill 959. Transparent Attempt to put You in the Back Seat of the Bus?

Jp Enlarged

Compounding is the pharmacist’s quintessential art.  It has been this way for centuries.  No one else has been trained to do it.  Unfortunately, these new (NAPLEX preparation) pharmacy schools don’t even teach it.  What does that tell you?  A new pharmacist told me that, when he asked about compounding, he was told that it wasn’t important.  Well, fuck me too, buddy.  Compounding is want can save the profession of pharmacy.  If you see more than slapping two ointments together when you hear the word compounding perhaps you can see what I am talking about.  If all you see is that outfit in Massachusetts killing some people with manufactured products they were sneaking through under the compounding umbrella, you are short-sighted.

A few points:  1. Modern medicine is drug therapy period.  2. Pharmacists still run that ship no matter how pissed off Pharma and the AMA get.  3. They have been trying to minimize pharmacy for 61 years when Durham-Humphrey became the law.  4. The AMA and Pharma ruined our chances for a BTC (Behind the Counter) class of drugs when William Apple and the APhA were fighting to get BTC drugs legal.  Yeah, don’t fall over from shock.  When Apple was President, the APhA actually led the way in promoting our profession.  5. We have been in a death struggle with the AMA for decades.  6. This doctor’s organization will fight to keep their turf and they will fight to take our turf away from us.  7. Talk about misguided.  There is enough turf for everybody.  9. The result of the AMA’s fight will be patient deaths.  I will wrap this list up and I could go on and on.  10. The AMA and Pharma will do just about anything to get drug therapy out of our hands.  11. As far as Senate Bill 959 goes, it is a sneak attack.  Read it carefully.  Perhaps a compounding pharmacist (actually any RPh) can give more than a cursory observation.  Apparently SB 959, in one sentence, differentiates between:  A. common compounds and B. complicated compounds.   You got it.  Pharmacist will be disqualified to prepare B.   If legislature allows them to get their pudgy little feet in ballerina slippers into the door, we are, once again, fucked.  Can you stop this?  Hell yes, but not by sitting in your chair after work, a beer in your right hand and a slice of pizza in the left and the game on your huge TV.  You gotta do something.  Compounding is yours, all yours.  Will you let Big Pharma take it away from you?  They want to sell more Androgel (example) and it pisses them off that the bio-equivalent transdermal HRT that you make takes so much of their market.

Jim,
From your reading your blog, it appears you have a very large and passionate group of pharmacists interested in your thoughts.

Today, I’m asking you to rally your following in opposition to Senate Bill 959, which will severely limit what compounding pharmacies can and can not compound.  More information about Senate Bill 959 is here:  http://www.protectmycompounds.com

As you know, practicing the art of compounding is one of the few ways independent pharmacies can thrive financially AND improve the overall well being of patients.  I fear that Senate Bill 959, in its current incarnation, will severely limit treatment options available to my patients and our financial well being.

View this page to easily contact your US Senator:

http://www.protectmycompounds.com/wp-content/uploads/2013/06/US-Senators-List.pdf

For info regarding one of the real motivations behind this bill:   http://www.anh-usa.org/compounded-medications/

I’m extremely worried about this bill because I’m a young pharmacist (33 years old) and currently in a junior partnership at Asheville Compounding Pharmacy.  I fear that Senate Bill 959 may squash or limit my intentions for Asheville Compounding Pharmacy over the next 30-35 years.  I love what we do, our employees love knowing they are making a difference, and our patients are extremely thankful for the high quality pharmaceutical care we provide.

Thanks for any help you provide regarding Senate Bill 959 and thank you for advocating for the pharmacy profession.

Sincerely,

John Clark, PharmD
Asheville Compounding Pharmacy
760 Merrimon Avenue
Asheville, NC 28804

AJ wrote a comment.  He ended it by stating that I am stuck in the 60s.  What better time to be stuck?  Haight-Asbury was a 30 minute drive from my apartment in Walnut Creek.   The music was outrageous.  The Beatles showed up in Golden Gate Park one Sunday.  The wine was cheap and the sex was still exciting (What happened with that?).  Never dropped acid, but did dope until one night I couldn’t remember how to untie my shoes.  Oh dear, on retrospect I believe that the joints the girl was passing around were Thai Sticks.  The 60s.  Still innocent.  The profit on prescriptions was 40%.  No computer to spy on us.  We made too much money in California and my wife spent it.  There are a few choices I’d like a do-over on.  The one that I remember in the middle of the night, staring at the ceiling, is the offer from a plain-looking girl with a fit and toned body.  She owned a new VW van and had it kitted up with camping equipment for two.  I liked her a lot and she liked me.  We sat on a blanket under a tree in Golden Gate Park a few Sundays in a row.  My wife was there, but not there.  The Almaden Burgundy was her pre-occupation.  The hippie girl was from Wisconsin.  Her wealthy farming parents couldn’t fight it, so they joined it.  They made sure that she had money.  She said, “Come on.  Let’s leave now.  We could be in Eureka by tonight.”  My heart squeezed.  I didn’t do it.  Two minutes after saying “No”. I knew it was a mistake.  She kissed me on the lips and looked into my eyes and got up and left.  I never saw her again.  Yeah, AJ.  I have 60s memories.  I am stuck.  Can your 2000′s memories match that?  Oh, I wasn’t a real hippie because I went back to work as a pharmacist after my weekends of posing.  Tune in, Turn on and drop out.  Dropping out was never an option.  

13 Comments

13 Comments

  1. John Clark  •  Aug 14, 2013 @5:41 pm

    Thanks for posting. You made a great point with ‘complicated compounds.’ Currently, the legislation doesn’t define ‘complicated.’ Potentially, all compounds could be labeled ‘complicated’, which would open the door for drug companies to start charging $200 for Estriol cream. Currently, compounded estriol cream (for most strengths) is less than $50 for 30 grams. Look at what ‘Big Pharma’ charges for Estrace 0.1mg/gm cream. Also, pharmacists should not forget the FDA significantly added to our health care costs by allowing a branded only version of cochicine (Colcrys).

  2. drsteverx  •  Aug 15, 2013 @2:05 pm

    As soon as the NECC disaster was happening, I figured there would have to be knee jerk responses from law makers. The thing is what NECC was doing was illegal and there are already laws against this. There are already standards in place. They chose to ignore these. More laws won’t stop people from ignoring said laws. It just makes it more difficult to do our jobs. I have contacted my reps and prompted my patients to do so as well. As an independent pharmacy owner, compounding is the last bastion of respectable profit margins. My avg rx profit would be abysmal without it. Not to mention it is one of the few areas that the chains won’t touch, probably because you need additional training and can’t just throw anyone into it.

  3. Rick Sadekoski  •  Aug 15, 2013 @5:09 pm

    Hey Jim

    In New York they are now going to have pharmacists and techs administer vision tests for dmv.

    Please don’t use my name

  4. AJ  •  Aug 17, 2013 @10:39 pm

    Jim, compounding is a money making scam. 99% of all compounded meds are unnecessary and done solely for the money. It’s interesting they have been able to fly under the radar so long. Thanks to some really shady and greedy outfits the scam is over. Most of these big outfits shipping prescriptions across state lines are manufacturing plain and simple. Trust me the insurance companies are going to shut down payment for them as well.

  5. AJ  •  Aug 17, 2013 @11:21 pm

    I have to chuckle at ‘ole Jim Clark’s statement. I am quite sure he would love to sell compounds at a 1000% markup for the next 30-35 years. It’s not going to happen thpugh. Everyone has caught on to the scam and are in the process of shutting it down. Oh my how could they!?!. Oh right because it’s sooo necessary to compound “bio-identical” hormones because 5mg of estradiol is just too much…but 4.1254786 is just right! Whatever…
    .
    Jim you are stuck in the 60′s my friend. Compoundings day has come and gone a long time ago.

  6. SeRPh  •  Aug 18, 2013 @12:55 am

    In response to AJ,

    I would like to see where you get your ’99% of all compounds are unnecessary’ from. It smacks of hyperbole. Also, while you are mentioning shady and greedy outfits, it would be remiss of you to not mention CVS/Caremark, Express Scripts, as well as Big Pharma and their overpriced drugs (Aricept 23 and Colcrys, I’m looking at you), and the politicians that facilitate their unbridled greed.

    Bio-identical hormones are just one part of compounding. One small part. There are many pharmacists out there who make a living compounding and don’t charge ’1000% markup’, but charge a reasonable price that the patient can afford and keeps them in business. I know this from experience. Larry Merlo gets $18 million a year now – is that reasonable? I doubt our friend John Clark is looking to join Mr. Merlo in the yacht club.

    Also, “Oh right because it’s sooo necessary to compound “bio-identical” hormones because 5mg of estradiol is just too much…but 4.1254786 is just right! Whatever…” is a naive statement. This implies a gross over-simplification of the kinetics and the effects of drugs in the human body. Medication dosages aren’t “one size fits all”. Go dose a patient’s Coumadin for a month or two, and tell me how the commercially available doses work out for you and your patient when their INR is all over the place. Good luck with that.

    Lastly – I seem to recall that you work in a PBM mail-order pharmacy? I would suggest that you are more than a bit biased in that case. Of course, the same could be said of me – as I am just getting into making compounds.

    But at least I have the satisfaction of knowing I am not screwing our patients over, and I am engaged in a dialogue with them and their provider to find solutions and make a patient’s life easier.

    When is the last time any pharmacist here every seen a PBM do that?

    Now if you’ll excuse me, I have to finish this prior authorization on promethazine tablets – afterwhich I will have the pleasure of explaining to another patient why Colcrys costs 60 times more than the colchicine she used to get, but is, in fact, the same medication.

  7. Steve Moore  •  Aug 19, 2013 @5:55 pm

    “99% of all compounded meds are unnecessary and done solely for the money”

    I don’t even know where to start with this. I’d expect ignorance like this from someone that didn’t know anything about pharmacy, not an actual pharmacist. That being said, a good place to start might be to fire the staff members responsible for the compounding portion of my business as what they do is apparently unnecessary.

    I’ll have to update my business plan too. Perhaps I can start repackaging, hiding rebates, and introduce spread pricing to my customers. Or I could always come up with a kickback scheme like the one involving Medco and CALIPERs from a few years ago. What I am trying to say is that anyone working for a PBM should be careful talking about money making scams as they can start to look silly pretty quick.

    Anyway, as much as the PBMs may want compounding to go away (no rebates after all), it is fundamental to the practice of pharmacy. They might realize that if actual practicing pharmacists, that could identify their patients given a book of photos, were involved in the decision making. Compounding is going to become more prevalent as the field of pharmacogenomics continues to expand. Those compounding and specialty pharmacies in compliance with USP guidelines will be the ones in the best position to meet the need for the individualization of therapy. PBMs will probably end up as glorified credit card processors, they are already being replaced by transparent PBAs.

  8. Goose  •  Aug 25, 2013 @9:04 pm

    If there ever is a line in the sand when it comes to pharmacy practice, this is it.
    If we don’t step over this line and save compounding, we deserve nothing and that is what we will end up with.
    Compounding is pharmacy and if you choose not to do it, you are not only limiting yourself professionally, you limiting the rest of us too.
    Compounding is the only magic we have left. If the PBM’s want compounding to go away, what better reason is there to be for it?

  9. broncofan7  •  Sep 2, 2013 @9:13 am

    Here’s an article from 2012 talking about the effect that pharmacogenomics may play on compounding……http://www.mdnews.com/news/2012_01/05731_foh2011_the-rise-of-genetics

  10. broncofan7  •  Sep 2, 2013 @9:21 am

    It’s unfortunate that AJ has become so indoctrinated by his employer that he actually believes that the Prior Authorization process that he partakes in to feed his family actually saves this healthcare system money.

    Having also worked in a PA department, I speak from experience that AJ isn’t the first Pharmacist nor will he be the last to mistakenly believe the corporate derived talking points are in fact truths. I worked along 2 Asian female Pharmacists who felt the same way that AJ did and although they were great people and good Pharmacists, I couldn’t believe their naivety when it comes to the BIG picture and our profession.

    In Summary, community Pharmacy is the backbone of our profession; Independent Pharmacy is the HEART of our profession with compounding a major artery of that heart. The overreach by congress in attempting to implement this bill while failing to realize that there were already laws in place and on the books to sanction/shut down these MANUFACTURERS of compounded products reeks of political motivation (Big Pharma)rather than good sound public policy.

  11. broncofan7  •  Sep 2, 2013 @10:42 am

    Rahm Emanuel: ” Never let a crisis go to waste”

    http://www.youtube.com/watch?v=1yeA_kHHLow

  12. bcmigal  •  Sep 2, 2013 @2:17 pm

    Rick from NY.. I apologize, I thought you were kidding…

    OVERVIEW from NY DMV Website:

    Currently, DMV permits doctors, nurses, and most eye care professionals to perform vision screening tests. DMV has changed its regulations so that pharmacists and their supervised staff are permitted to conduct vision screening tests for customers. Supervised staff of current health care professionals are also permitted to conduct the tests along with organizations deputized by DMV. Concurrent with expanding the regulation, DMV has developed an Online Vision Registry that allows the test results to be electronically submitted to DMV and applied to an individual’s record to aid customers in renewing their licenses online or by mail without having to visit a DMV office.

    The vision screening test is a very simple process, requiring just seconds to complete – it is literally as simple as asking the customer to read one line from a Snellen chart mounted on a wall or screen. The online enrollment process and test result entry is very streamlined and user friendly. With internet access, any business can easily enroll in the Registry, conduct tests and enter results providing a valuable service for its customers. The combined process of conducting the test and entering the result in the Registry requires a very small investment in time by staff.

    Participating organizations (except for organizations deputized by DMV) are free to charge a fee for the service although many of those currently authorized to provide the screening test under the current regulation offer the vision screening exam to their established customers as an added service at no cost.

    BENEFITS OF PARTICIPATION

    Customers will be pleased that you are providing this service, increasing their satisfaction.

    The added service may increase walk-in traffic in your businesses.

    Your business will be identified as an authorized vision screening provider on DMV’s Web site and in other promotional materials.

    (Love the “benefits” section.We are “deputized” to offer this service for free! OMG!)

  13. Pharmaciststeve  •  Sep 2, 2013 @4:16 pm

    That is great.. the DMV is able to cut staff – that get paid – and get some stupid/greedy retail entity to do the DMV’s work…for them for free.
    I guess they couldn’t convince the DMV’s worker to work for FREE…

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