OUR ART OF COMPOUNDING IS INTUBATED!
Compounding in community pharmacies is of vital importance both economically in terms of observing the public interest and with respect to enhancing the quality of patient care.
On the other hand, the importance of magistral compounding—the true art of the pharmacist—is indisputable in preventing the proliferation of modern pharmacy models where the pharmacist is increasingly marginalized.
Preparing medicines, namely magistral formulas, in our pharmacies has been consistently practiced ever since pharmacy education attained an academic level. In this century, the fact that industrial drug manufacturing has peaked globally in every aspect has caused in-pharmacy medicine preparation to decline and has progressively diminished physicians’ habit of prescribing magistral formulas.
Compounding in the pharmacy essentially means bringing the ongoing practice of magistral preparation up to modern standards.
We must revive the concept of compounding, which elevates the status of pharmacists in society by transforming pharmacies from mere logistical points of drug distribution back into productive, medicine-manufacturing healthcare environments.
For all these reasons, through the Magistral Pharmacists Association that we founded a year ago, we continue our efforts to advance the Art of Compounding in our country through training programs and to eliminate the obstacles standing before our profession. Our goal is to develop our art and reach the level of contemporary nations in a short time.
In the meetings held by our Association with the authorities to contribute to the resolution of our issues, we have repeatedly stated:
– That forcing pharmacists to prepare magistral medicines according to the 2015 prices of the Magistral Tariff not only causes economic losses to pharmacists, but also, as identified in a study conducted by our association, inflicts severe financial damage on the public treasury regarding certain raw materials listed in the tariff; pointing out that the chemical industry has a highly dynamic structure both globally and domestically, we are adversely affected by rapid price fluctuations driven by production volume and supply-demand balance, and that it is impossible to prepare medicines today based on a magistral tariff last calculated according to 2015 inflation rates; and we have repeatedly affirmed our readiness as the Magistral Pharmacists Association to contribute to initiatives carried out in this regard,
As is known, according to Misdemeanor Law No. 5326, selling medical preparations and magistral formulas above the price determined by the Ministry of Health is among the acts considered an offense in pharmacy and is subject to punitive sanctions.
However;
With the approval of the Ministry of Finance dated March 23, 2011, and the provision “Article 14: The prices listed in the tariff and its appended schedules shall be republished at the beginning of each year by adding the revaluation rates published by the Ministry of Finance”, the difficulties experienced regarding revaluation were resolved, and the annual update of the magistral tariff was guaranteed. Although it was stated that “any adjustments to be made after this date regarding the magistral tariff prepared by the TEB, currently in force, and used for pricing magistral products manufactured in pharmacies are deemed appropriate to be updated by applying the revaluation rates determined annually by the General Communiqué on Tax Procedure Law published by the Ministry of Finance pursuant to Tax Procedure Law No. 213, and to be published accordingly by the General Directorate of Pharmaceuticals and Pharmacy without requiring a new approval,” unfortunately, the magistral tariff has not been updated since 2015. Consequently, in the current process, pharmacists are forced to prepare medicines at a financial loss in order to avoid facing punitive sanctions under Misdemeanor Law No. 5326. We emphasized that the sluggish bureaucratic procedures or the authorities failing to perform their duties, thereby exposing pharmacists to these penal actions, must have ethical and legal accountability,
Furthermore, summarizing the necessary adjustments in the magistral tariff within this framework:
· It is important to organize the names of raw materials in Turkish, including Latin names alongside them where necessary,
· Consolidating raw materials that are repeated under the same or different names in the tariff into a single entry,
· Identifying and removing obsolete raw materials that have lost their therapeutic value for various reasons, and replacing them with raw materials used in modern treatments,
· Re-adding the preparation of suppositories, which was removed from the tariff, and reviewing details such as sterilization,
· Pricing raw materials in the tariff not only by weight but also by volume,
· Eliminating non-standard deduction reasons made by auditing pharmacists reviewing magistral prescriptions through the implementation of a dedicated Magistral SUT (Healthcare Implementation Communiqué),
Additionally;
During the initial days of the COVID-19 pandemic, when pharmacists produced hand sanitizers in their laboratories, the vital importance of magistral compounding for public health was demonstrated once again. Yet, we have highlighted that an incomprehensible restriction of 2 liters of Ethyl Alcohol per month imposed on pharmacies would cause serious complications in pharmacy hygiene and magistral compounding, ultimately leading to patient victimization.
The COVID-19 Pandemic introduced us to many new terms and concepts. Chief among these is intubation. The purpose of respiration, which is a vital bodily function, is to provide the oxygen required for the sustainability of life to all cells in our body and to eliminate carbon dioxide, the waste product of cellular metabolism, from the body.
Intubation is required when a person develops respiratory failure. In conditions such as severe lung injury, severe pneumonia, and COVID-19, the intubation procedure may be necessary to meet the patient’s oxygen needs.
Intubation is a procedure applied to patients who cannot maintain airway control or perform the act of breathing without assistance.
While reminding the authorities once again that the barriers in front of our profession must be removed urgently to enhance the feasibility of magistral production—which plays a crucial role in compounding orphan drugs unavailable in the community for various reasons and contributes to the advancement of the art of pharmacy—we wish to declare once more that the Art of Compounding is INTUBATED, and if action is delayed, it will be lost. 25/04/2021
On behalf of the Board of Directors of the Magistral Pharmacists Association
President
Pharm. Spec. Ahmet Nezihi Pekcan
