Letters to the editor

Compounding dos and don'ts AstraZeneca was encouraged by the article "Compounding Pharmacies Come Under Attack" (April 18), as it highlights potential dangers associated with pharmacy-manufactured medications, including the lack of assurance to patients and physicians that these drugs are safe and effective. We commend Drug Topics for highlighting this growing issue.

AstraZeneca does support legal compounding-when a pharmacist in direct consultation with and at the request of a physician, fills a prescription for a product that is not commercially available and is necessary for treatment of the patient. When products are compounded in place of a commercially available product, patients have the right to know that the medication they get from their pharmacy is identical to what their physician prescribed. ePhysicians need that same assurance; otherwise, their ability to effectively and safely trat the patient is at risk.

As the article notes, compounding pharmacies are regulated by states, skirting federal standards of safety and efficacy. However, such pharmacies often market their products as identical to or indistinguishable from FDA-regulated products.

While most pharmacists compound drugs safely in consultation with physicians, consumers should be aware that the FDA has found large-scale compounding operations that function without regard to good manufacturing practices. These unscrupulous operators have been cited for neglecting to clean, maintain, and sanitize equipment, mishandling sensitive solutions, and failing to ensure that each batch of drug product conforms to specifications.

AstraZeneca commends the work of CHASM (Consumer Health Alliance for Safe Medication), which shares our concern for the safety of patients who may receive a compounded product unknowingly.

We also wish to remind pharmacists that there are no FDA-approved generics for PULMICORT RESPULES (budesonide inhaled solution), and that compounded budesonide is not the same as PULMICORT RESPULES. In fact, these medications have significant differences (e.g., solution dissolved in alcohol vs. suspension), and compounded budesonide may have adverse consequences for patients.

For more information, we encourage readers to visit http://www.knowthedifference.org/.

Harvey Maldow, R.Ph., M.S.
Director, Professional Relations
AstraZeneca LP, U.S.
Wilmington, Del.

Blues contract no good While reading your May 16 issue, we couldn't help noticing the article entitled "Minnesota Blues offers 90-day retail scripts," as we are the owners/operators of two community pharmacies based in the Minneapolis/St. Paul metro area. We noted that this article seemed to be commending, even praising, Blue Cross/Blue Shield for beginning to offer a 90-day supply of prescriptions for two co-pays, thereby placing community pharmacies on a level playing field with mail-order pharmacies.

We received a contract offer from Prime Therapeutics (Blue Cross/Blue Shield), dated Oct. 4, 2004. The contract offer stated the following provisions regarding the reimbursement rate: Brand-name drugs: AWP - 22% plus $0 dispensing fee; generic drugs: AWP - 55%; or PrimeMail MAC plus $0 dispensing fee.

If so desired, by the Blue Cross member, a pharmacy must allow the member to receive his/her medications by mail and the pharmacy cannot charge the member any additional fee for this service.

The terms of this contract mean our pharmacies would be reimbursed between $.50 and $1 less than our cost of acquisition on each brand-name prescription fill, if we were to participate in this program. On certain generics, reimbursements could be as much as $30 less than our cost of acquisition. How can this be a viable alternative for community pharmacies? On face value, the actions of insurers such as Blue Cross/Blue Shield seem to be commendable. However, this is obviously not a realistic opportunity for community pharmacies such as ourselves. These types of "opportunities" not only hurt pharmacies but twist the dagger in us as well.

Chris Jeffrey, CPA
VP-Business Development
chris@ramseyrx.com

Wayne Jeffrey
President