“Nil desperandum”
Never give up!
If you recall, on 27.03.2016, I shared my article titled “Don’t Do It” with you in my column regarding the unfair deductions made by the SSI concerning Pantocaine. In the notifications sent from the SSI to our colleagues around those dates, it stated verbatim:
“Based on the opinion stated in the letter dated … and numbered … of the Faculty of Pharmacy of …… University, pursuant to the investigation report prepared as a result of the inquiry conducted by our Institution’s Guidance and Inspection Department and the approval of the Presidency regarding the report, which indicated that ‘the active substance named pantocaine, due to its local anesthetic properties, can be used at a concentration of 0.5-1% in topical prescriptions, and also at a concentration of 4% as a percutaneous local anesthetic in venous cannulation’; the joint and several collection of the payments made, together with legal interest, due to erroneous prescription formulations from the physicians who prescribed magistral preparations containing the active substance pantocaine billed to our Institution in high concentrations and from the pharmacies that billed them to the Institution”
In response to the unlawful and unfair deductions made from Pharmacies and prescribing Physicians based on the letter beginning with these words, I mentioned that tetracaine is prescribed worldwide and available as specialty products on Pharmacy shelves at rates of 2% in dentistry and up to 7% in local use, and that this formulation has been approved by the FDA. Furthermore, I stated that the medication named OTİMİSİN DROP, which is approved by the Ministry of Health in our country and reimbursed by the SSI, contains the active substance pantocaine at a rate of 2.2%, noting this as a contradiction and arguing that these deductions should be revoked. Justifiably, with this logic, I had asked the question: “Will there also be deductions for prescriptions containing Otimisin?”.
I had criticized SGK for consulting only one of our universities while making these deductions, stating that it was not right to evaluate all prescriptions with this mindset based on an isolated case of abuse, that our colleagues working at SGK possess the knowledge and competence to distinguish abused prescriptions from other prescriptions, and that since this situation subject to deduction is too technical to be left solely to the evaluation of the SGK Guidance and Inspection Department, we expect our colleagues serving in the institution to take initiative in rectifying this mistake.
When writing that week’s article, the title of my piece was “DON’T DO IT”.
Indeed;
first of all, I am calling out to those who cause abuse… Don’t do it…
Then… I called out to those who, seizing this abuse as an opportunity, send these notices that demoralize, demotivate, and economically torment our colleagues who are struggling to survive under increasingly difficult economic conditions every passing day, having no other thought than dispensing the prescriptions brought to their pharmacies and serving patients… Don’t do it…
I had virtually cried out: ‘Look, as a result of this, you will unfortunately not find any pharmacies left to prepare compounded (magistral) formulations or physicians to prescribe them, which are already decreasing day by day for known reasons. An art is on the verge of extinction.’
Finally, the ANKARA 5th CIVIL COURT OF FIRST INSTANCE found our objection justified and delivered an exemplary decision, ensuring the rectification of a wrongdoing.
In the reasoned decision;
…stating that based on the opinion obtained from the Faculty of …, the defendant institution demanded the reimbursement amount of the prescription containing the extemporaneous (magistral) medication under the claim that the active substance pantocaine prepared by their client was used in excess of the specified ratio; that the doses of the active substance were determined by the physician according to the severity of the disease present in the individual for whom the medication was specifically prescribed and prepared; that there is no standardized formula; that there is no SUT (Health Implementation Communiqué) for extemporaneous formulations; that pursuant to Article 25 of Law No. 6197, the pharmacist is obligated to prepare the medication in accordance with the prescription; that there was no information regarding the maximum doses of the active substance pantocaine in the institution’s notice; and that deductions cannot be made from their client without reviewing the applicable legislation, thereby requesting the resolution of the dispute by revoking, together with all its consequences, the defendant institution’s letter dated 14.04.2016 and numbered 42046020/5676181 and its underlying letter dated 18.03.2016 and numbered 42046020/4.267.463,
…that the pharmacist is obligated to dispense the prescription contents if no irregularity is observed; that in the procedure applied to the pharmacy, only the opinion of a single university was sought, without consulting other universities or utilizing scientific sources; that there is no binding clause regarding deductions in the protocols; that reimbursement terms in the SUT are established only for manufactured pharmaceutical products; and that the pharmacist fulfilled their professional responsibility pursuant to Article 25 of Law No. 6197 on Pharmacists and Pharmacies, and thus the institution’s action was deemed inappropriate…
It is reported that the magistral solution prepared by the plaintiff pharmacist contained 1.87% pantocaine. A magistral medication is a type of medicine prescribed by a physician in a custom or established formulation and requested to be prepared by a pharmacist, or a medication not commercially available in pharmacies but prepared by pharmacists according to the formula prescribed by a doctor. The pharmacist has no involvement in determining the formulation ratio. Moreover, regarding the administration of the medication prepared by the pharmacist to the patient, there are differing opinions among universities and in medical literature indicating that it can be used at rates of 0.25–2% according to some, and 0.5–1% according to others for local and topical anesthesia. It was determined by the expert panel that it is used up to 4% in many countries, and according to opinions in the field of pharmacology in our country, its maximum dose is in the form of a 2% solution. There is also no ratio determination regarding the ratios of magistral drugs by the SSI in the contract and SUT (Health Implementation Communiqué). Article 25 of Law No. 6197 on Pharmacists and Pharmacies states that pharmacists are responsible for errors and the like in medications of prescriptions left at the pharmacy for preparation, that they may prepare excess drugs written in prescriptions suspected of containing inaccuracies in their content only after consulting with the physician, and that if consultation is not possible, the situation must be reported to the health authority.
From what is described above, since it was concluded that the plaintiff pharmacy prepared the prescribed magistral medication and delivered it to the relevant patient, that the ratio in the prepared magistral solution was 1.87% and did not exceed the highest ratio of 2% as stated in scientific opinions, and therefore no penalty could be imposed on the plaintiff pharmacy based on exceeding the ratio in the magistral medication, the acceptance of the lawsuit… 28/02/2017
While applauding this rightful decision rendered by the Supreme Court, I consider it a duty to express my gratitude to Atty. Abdullah Dursun ÇAKMAK and Sosyomed Management Consultant Ms. Şebnem Akgün for their sensitivity to the issue and their dedicated efforts throughout this process.
Long live justice…
“Audemus jura nostra defendere”
We dare to defend our rights.
Spec. Pharm. Ahmet Nezihi Pekcan
Pekcan Pharmacy – Konya
[email protected]
Tel: (332) 3520657
http://www.majistralformul.com/
Pekcan Pharmacy – Konya
[email protected]
Tel: (332) 3520657
http://www.majistralformul.com/
