Urgent call for reform on magistral preparations!If we look at the historical process in our country regarding the pricing of magistral formulas prepared in our pharmacies; the first Ottoman Official Drug Tariff was prepared after 30 years of work and debate, but unfortunately, its lifespan was only one month.
Another piece of legislation that came into force in 1895, prepared to determine the method to be followed in establishing the prices of compounded medications in pharmacies and thereby prevent discrepancies in drug prices, was the drug tariff. (Le Tarif des Pharmaciens)
Since there was no official price tariff during the Ottoman Pharmacy period, pharmacists determined the prices of the medications they prepared based on customs and personal opinions. This practice led to different prices being charged for the same prescription at different pharmacies and even gave rise to bargaining. The fact that one pharmacy charged 50 kuruş for a prescription, another asked 20 kuruş, and a third requested 31 kuruş caused the public to distrust pharmacists.
Pharmacists advocated that the implementation of an official price list would facilitate their work, strengthen their financial standing, prevent unfair competition, and increase their respectability among the public. As a result of strong demands in this direction and prolonged efforts, the “drug tariff” prepared by a special commission composed of the Meclis-i Tıbbiye-i Mülkiye (Conseil des Affaires Medicales Civiles) and pharmacist representatives entered into force in May 1895. In accordance with this tariff, rather than taking a certain profit margin on the ingredients used in compounding the medication, the principle of covering the pharmacist’s professional (art-science) fee was taken as a basis in determining the drug price.
Shortly after the tariff went into effect, the public, newspapers, and some pharmacists began to lodge severe complaints that drug prices calculated according to the new tariff were excessively high. Thereupon, the government suspended the implementation of the drug tariff and decided that the tariff should be reviewed and necessary amendments made by a special commission to be established.
Thus, the first Ottoman Official Drug Tariff, prepared after 30 years of work and discussion, unfortunately lasted only one month. (Source: Dr. Mahmut Tokaç “Kırmızı çizgi”)
Today, if we take Belgium as an example among European countries where various pricing methods are applied for magistral formula calculations; a reform regarding magistral preparations came into effect in Belgium as of April 2014, and in this new regulation, new prices and new professional fee rates were introduced exclusively for magistral preparations. Accordingly, magistral products are priced based on an “all-inclusive” method that covers the preparation type, time spent, ingredients, and materials. Under the new regulation, all magistral preparations are divided into 3 distinct categories based on the time spent, each corresponding to a different fee rate.
1-Simple preparations (capsules, solutions…) 20 minutes, €12.93
2-Dermatological preparations (creams, lotions…) 32.5 minutes, €21.03
3-Complex preparations (suppositories, ovules…) 50 minutes, €32.35
In our country:
As a result of the efforts of the Turkish Pharmacists’ Association (TEB), with the approval of the Ministry of Finance dated March 23, 2011“Article 14: The prices specified in the tariff and its annexed schedules shall be republished at the beginning of each year by adding the revaluation rates published by the Ministry of Finance”with this provision, the difficulties experienced regarding revaluation have been overcome and the annual updating of the magistral tariff has been guaranteed.
However;
prepared by the Turkish Pharmacists’ Association (TEB), currently in effect, and used in the pricing of magistral products prepared in pharmacies,“it has been deemed appropriate that future adjustments for the ‘magistral tariff’ after this date be updated by applying the revaluation rates determined by the Tax Procedure Law General Communiqué published annually by the Ministry of Finance pursuant to Tax Procedure Law No. 213, and published by the General Directorate of Pharmaceuticals and Pharmacy accordingly without the need for a new ‘Approval’.”Although it was stated that […], unfortunately, since 2015, the magistral tariff has not been updated in any way. There is an urgent need to reorganize the magistral tariff as soon as possible, both in terms of content and because it fails to compensate the pharmacist’s labor, as well as because the raw material prices listed in the tariff remain far below the amounts invoiced to pharmacies by supplier companies. In a research article published in the Marmara Pharmaceutical Journal in 2015, it was determined that 63% of pharmacists avoided preparing magistral prescriptions due to the lack of financial return on compounding medications.
The magistral tariff needs to be revised not only in terms of pricing but also in terms of content. In the forthcoming regulations, a need has arisen to enrich the content of the magistral tariff with a variety of raw materials that can meet today’s modern compounding formulas, to purge substances that have lost their therapeutic value, to price raw materials in the tariff not only by weight but also by volume, to implement a Magistral SUT to resolve reimbursement issues experienced by pharmacists with the Social Security Institution, to re-add suppository preparation which was removed from the tariff, and to review details such as sterilization.
It is known that pharmacists in developed countries offering top-tier pharmacy education initiated their first efforts in 1986 to halt the estrangement and decline of community pharmacists regarding medication preparation in their workplaces. Although the same initiative was brought to the agenda in our country in October of the same year by TEB under the title “Medication Production in Pharmacies” and some work was carried out, unfortunately, no significant progress has been made to date. Resuming this process from where it was left off today is an absolute necessity for the present and future of the pharmacy profession.
We must revive the concept of compounding, which transforms pharmacies from mere logistical points for supplying medications to patients into productive spaces, recreating the concept of the medicine-manufacturing pharmacist and enhancing the prestige of pharmacists in society.
During the process we experienced, the hand sanitizers produced by pharmacists in their laboratories in the early days of the Covid-19 pandemic once again demonstrated the importance of magistral compounding for public health.
In order to increase the feasibility of compounding production—which is vital for preparing orphan drugs that cannot be found in the community for various reasons and contributes to the advancement of the art of pharmacy—we urgently demand pricing that provides fair compensation for the pharmacist’s professional labor, as well as an update of the tariff’s content.
To summarize, we call on the authorities for an urgent reform regarding magistral preparations, primarily concerning the content and pricing of the tariff, and we declare our readiness as the Magistral Pharmacists Association to contribute to this process.
Spec. Pharm. Ahmet Nezihi Pekcan
Pekcan Pharmacy – Konya
[email protected]
Tel: (332) 3520657http://www.majistralformul.com/
