111 posts categorized "Pharmacy Practice"


Healthcare in Transition

The Trump administration began with the bold declaration to end the Affordable Care Act (ACA).  As time has passed, this has proven more difficult than the president originally planned.  The problem has become that the lack of clarity upon what will happen as health insurance is reworked.  This uncertainty has led to insurance companies losing their desire to stay in the ACA market places.  Already, the ACA has resulted in one insurance company, Humana, suffering from particularly difficult losses and quitting the market place.  With even more questions about the future of healthcare laws, it stands to reason that more health insurance agencies will follow.  For this reason, the Trump administration has decided to make interim rule changes to increase the solvency of the program until the new program has been created.  In short, these changes are three-fold:  first narrowing the enrollment window, second expanding the definition of silver-care plans and lastly giving more time for insurers to create plans for 2018.  My goal in this post will be to assess how it will affect insurers, the public and add a bit more context to the problems associated with repeal that have occurred.

Moral hazard is when one party partakes in behavior that can negatively impact another party.  For health insurers under the ACA, this is when individuals opt to join an insurance company only upon realization that they were sick.  This behavior should theoretically have trade-offs.  The fact that adverse selection for pre-existing conditions can no longer occur removes the major incentive against such actions.  Thus, it is wiser to not sign up for healthcare until it is necessary.  The problem that such waiting causes is that insurance is based on a sick-healthy ratio, and additions of sudden sickly individuals would decrease the profits that they had projected to earn.  By narrowing the time frame associated with late-term insurance enrollment, the ability of insurers to ensure profits intrinsically rises.  The fallout of this change, however, is that it may lower the amount of young people who can get insurance in the first place.  The people most likely to enroll at the last minute are the young.  These are individuals who are most needed for insurance companies to thrive.  In this way, the new regulations are a double-edged sword.  By eliminating the younger, more beneficial aspect of the ratio, Trump’s Health and Human Services department (HHS), has made it such that the potential to end up with a more sickly pool of people for insurance companies is higher.  If this were to occur, it would back-fire in its implementation yielding a more unstable market for insurance companies.

Under the ACA, the insurance market has various tiers for the health care plans.  They are summarized in descending order of value as platinum, gold, silver and bronze.  Under the current regulations, silver plans have an actuarial value (AV) of 70%.  By this it is meant that if an individual from a standard population needed healthcare, 70% of their healthcare expenses could reasonably be expected to be covered.  In implementation, a range variance exists allowing for +2 points of coverage meaning insurance companies actually pay between 68-72% of costs.  The change the Trump administration hopes to put into effect would allow a lower minimum value.  Under the new regulations, the variance range would become -4/+2.  By increasing the variance, a silver plan could now have an AV of 66% instead of the current 68%.  This would greatly increase the number of plans an insurance company could create.  However, it would also lower the value of the plans in question.  So while insurance companies would definitively benefit from this change, for the consumer, it is a mixed blessing.  By increasing the burden on individuals, a stronger argument could easily be made for a health reform bill to replace the ACA. However, it would also go counter to the desires of the constituents who voted for President Trump.  Interestingly enough, the change to AV values will have far broader implications than one might initially think.  This owes to the way that tax credit costs are currently calculated.  Since tax credit costs are based on Silver plan values, tax credits given by the government would be directly impacted by these changes.  The tax credit value, known as the “benchmark”, is based on the second lowest value silver plan in an individual’s area.  The amount of tax credit for an individual could be as low as 66% of the cost rather than present minimum of 68%.    Since the tax credit would be lower, it can then be safely assumed that some individuals may not be able to afford the more expensive plans. Thus, insurance companies may see a decrease in enrollment.

The new administrations is realizing that creating a new healthcare law is more difficult than originally believed.  This owes to the fact that the ACA may have many problems, but has done a large amount of good for the nation as a whole.  If nothing else, the number of uninsured Americans has dropped substantially thanks to the law.  The general anger from Trump supporters about the healthcare law seems focused on its limitations and the lack of value from the law.  This makes it far more problematic to create a new healthcare law when all current plans are similar to Rand Paul’s replacement bill, see here or Tom Price’s plan see here.  The part of the ACA most often cited as problematic is the individual mandate.  Some have criticized it as “un-American”.  This stems from the fact that it is the federal government forcing individuals to buy insurance.  The problem is that removing the mandate would only serve to destabilize the insurance market.  Insurance companies would constantly raise rates in an attempt to make-up for the losses.  Eventually, insurance might become virtually unfeasible for the American population.  At this point everyone loses health insurance.  At the same time, the world is not stopping for the Republican Party to make a better law.  So by expanding the time before insurance companies must give a decision about staying in the market place, the Trump administration hopes that it will be able to alleviate the short term problems while a much better long-term alternative takes shape.

Ultimately, the ACA is a bill that has proven a transformative bill for American healthcare.  While certain specifics, like the individual mandate, are not well received, the bill has had success in getting more people health insurance.  There is a good case to be made that the Trump administration’s changes to the health law could help stabilize the market.  The problem is that the basis for that argument is also the basis of the reverse effect happening, making the situation worse.  Allowing for worse overall healthcare for some as a trade-off to stabilize the market can easily be made thanks to the steadily more plausible idea of a death spiral.  At the same time, putting the burden on the most susceptible Americans will strike a nerve with many who fight for the voices of the poor.

My opinion is that, reluctantly, the changes could yield a net good for the nation.  By this I do not mean that all the changes are for the best, just that there is enough well thought out logic to see why the Trump administration is making these particular changes.  However, the ultimate problem is that so long as questions about a new healthcare system remain in the balance, these temporary patches will only serve as the equivalence of tying a tourniquet to a man bleeding to death; a temporary fix without much value if proper treatment is not issued as soon as possible.

Kunle Adejare, PharmD '19


More Faculty, Staff, Student and Alumni Achievements

Karin Richards, chair of the department of kinesiology, presented at the Regional Conference on Aging on the topic Calm Minds, Active Bodies.

She will also be presenting at on “Applying Behavior Change Techniques” at a workshop in Richmond Virginia.

Richards was also selected as a master trainer by the American Council on Exercise for applying behavior change techniques

 Paula Kramer PhD, OTR/L, FAOTA, director of the post-professional doctor of occupational therapy program, has been invited to give the keynote address for the New York State Occupational Therapy Association conference on November 5.

 Dorela Priftanji PharmD’17 was awarded the Pennsylvania Society of Health System Pharmacists Student of the Year Award at the annual assembly.

 Several faculty members and former colleagues were published in the American Journal of Pharmaceutical Education, Vol. 80, Issue 7. “Variables Affecting Pharmacy Students’ Patient Care Interventions during Advanced Pharmacy Practice Experiences” was a collaborative effort of Laura Bio PharmD, Brandon Patterson PharmD, PhD, Shanta Sen PharmD, Angela Bingham PharmD, Jane Bowen PharmD, Ben Ereshefsky PharmD, and Laura Siemianowski PharmD.

Jim Holaska PhD, associate professor of pharmaceutical sciences, recently published two articles listed below. One of the articles was a comprehensive review of diseases associated with mutations in nuclear envelope proteins and the proposed disease mechanisms. The second review focused on the cellular function of one of these proteins named emerin and how mutations in this protein cause muscle disease.

  1. Holaska, J. M. 2016. Diseases of the Nucleoskeleton. Comprehensive Physiology. 6:1655–1674.
  2. Collins, C. M., Nee, K. A. and Holaska, J. M. 2016. The Nuclear Envelope Protein Emerin and Its Interacting Proteins. eLS. 1–9.

Jessica Adams PharmD, assistant professor of clinical pharmacy, attended the 6th Clinical Pharmacy Summit in Manila, Philippines Sept 16-18th as faculty for ACCP. She presented on HIV, tuberculosis, sexually transmitted infections, opportunistic and fungal infections, and intra-abdominal infections to a group of pharmacists from the Philippine Pharmacists Association who are preparing to take the BCPS exam.

Amy Jessop PhD, MPH, associate professor of health policy and public health, and a recent grad, Muhamed Gashat MPH ’16 penned a paper entitled "Barriers to HCV Treatment in Methadone Users" was highlighted on the National Aids Treatment Advocacy Project (NATAP.ORG).

 Evana Patel PhB'16 won best paper in her session at the Academy of Business Research Fall 2016 Conference in Atlantic City


PCP Student Receives Travel Grant for National Conference

Christina Ly- Professional PictureChristina Ly PharmD’17 was one of only four students selected nationwide to receive a travel grant worth up to $2,500 from the American College of Apothecaries (ACA), International Academy of Compounding Pharmacists (IACP) and American College of Veterinary Pharmacists (ACVP) Foundations. Ly received the award at the 2016 ACA/IACP/ACVP Educational Conference held from February 24-27, 2016, in Coronado, CA.

The Educational Conference is a joint endeavor by the three hosting organizations, ACA, IACP, and ACVP. The conference provides continuing education sessions to pharmacists and pharmacy technicians that are focused on topics related to independent pharmacy, pharmaceutical compounding, pharmacy law, and veterinary pharmacy. In addition to attending educational sessions, travel grant winners have the opportunity to attend an association board meeting and network with working professionals from across the country. Information on the Educational Conference can be found at www.educationalconference.org.


Introduction to Biosimilars

As clinical guidelines are published and the pharmaceutical industry innovates, the practice of pharmacy changes. At the fore front of innovation is the biologic. These medications are capable of achieving clinical outcomes that traditional small chemical medications cannot. Biologics are not without disadvantages. In addition to being more challenging to create, these medications are also orders of magnitude more expensive. This cost has kept biologics as an alternative or not even an option to patients who would greatly benefit from their use. In order to solve this issue, the pharmaceutical industry is developing biosimilars, or medications that are similar to existing biologics and are offered at a lower cost.

Most medications that are found in a pharmacy are small molecule products. These drugs are synthesized chemically and have been relatively cheap to produce. When a small molecule drug is first offered on the market by a single proprietary manufacturer, they are known as brands drugs. The costs of these products are typically high for a regulated period of time, that proprietor is the only entity legally allowed to produce that drug. This creates a temporary monopoly, allowing the proprietor to sell at a price with no competition. After that period of time is up, other manufacturers are allowed to create what is known as generics. This system of proprietor creation and then generic competition is regulated by the Hatch-Waxman Act. This legislation has two goals. The first is to create an incentive for new drug creation by allowing innovator manufacturers enough of a monopoly to make a profit despite high research and design cost. The second is to lay down a framework where generics can come in and make prices reasonable for patients. When both goals are met, a balance is struck between continuing innovation and low drug costs. Hatch-Waxman has created a model that works well for the brand-generic model which for the time being describes the inventory of most pharmacies.

For biologics, this model cannot be applied. The reason for this difference is due to the method of how biologics are synthesized. Biologics are made from genetically engineered cells. These cells then create proteins which are then isolated. As you can imagine, this process is much more complex and difficult. The process for engineering these cells may be trade secrets which means non-proprietary manufacturers must come up with a different way to arrive at a similar protein. The fact that the active pharmaceutical ingredient is a protein makes replication more challenging for non-proprietary manufacturers. A protein’s function is in part derived from its tertiary structure, the way in which the protein is folded. Slight alterations in the amino acid chains which make up the protein could alter tertiary structure and therefore alter is function. In other words, the creation of generics for biologic proprietary medications are nearly impossible.

This is where biosimilars come into the picture. Biosimilars are highly similar medications to a reference product. A reference product is like the brand product of the original model. The sponsors of the biosimilar must go through a new legal route before they can market the product. Thus far, that legal pathway has been through the Biologics Price Competition and Innovation (BCPI) Act. This act is designed to work similarly to the Hatch-Waxman Act. The BCPI is not the complete story however, leaving the path biosimilars must go through unclear. The amount of research needed for a biosimilar and the time that it will take to develop a biosimilar for example are still unknown.

In conclusion, biosimilars are medications that are clinically similar to proprietary biologics and can be produced and sold at a lower cost. Due to the complex nature of biologics themselves, biosimilars will not be the new generics but could lower health care costs and bring innovative pharmacotherapy to more patients.

Robert Bond, PharmD '18


Lowering Drug Costs and the 340b Drug Pricing Program

In order to protect patients from high drug costs, the Centers for Medicare and Medicaid Services (CMS) offers several plans qualifying patients can sign up for (more information available here). There are patients however, who are in need of federal assistance on drug costs but do not qualify for one of these plans. In order to reach some of these patients, the congress created a policy under section 340B of the Public Health Services Act. This policy is managed by the Health Resources and Services Administration (HRSA) and is known today simply as the 340b drug pricing program.

This program is aimed at the hospitals and medical centers who likely treat these underserved patients populations. These organizations are known as , covered entities.   Examples of covered entities include, but are not limited to Federally Qualified Health Centers, Ryan White HIV/AIDS program grantees, children’s hospitals and sexually transmitted disease clinics (full list found here). Patients at these facilities who qualify benefit from access to 340b covered drugs because their drug costs will be significantly less than patients not eligible for 340b drugs. These facilities will benefit because the manufacturer and wholesaler are obligated to sell these drugs at the low 340b price. These savings are typically 23.1% for brand products and 13% for generic products. Covered entities also have the ability to negotiate lower prices from those discounts which would result in further savings. These entities are then reimbursed by Medicaid at slightly higher prices which fall somewhere above the actual acquisition cost or AAC. AAC is what the pharmacy pays for drugs. It therefore factors in all sales and discounts the pharmacy may receive from a wholesaler. Medicaid may pay pharmacies at slightly higher than AAC in order to incentivize pharmacies to participate in the 340b drug pricing program.

The 340b pricing program is still a work in progress. One of the principle issues has been compliance with the program. It can be difficult for covered entities to follow the rules HRSA has established for the 340b program. Imagine that there is a pharmacy with 10 stock bottles of a maintenance drug. One of those bottle was purchased for a 340b patient at a 340b price. The challenge is ensuring that only the 340b patient receives medication from the 340b stock bottle. This becomes incredibly difficult when you factor in many 340b patients on multiple medications. If patients who are covered by Medicare or Medicaid received 340b drugs at typical prices (AWP minus a negotiated percentage) then federal resources would be spread too thin to help the underprivileged.

Fortunately, more changes are expected to occur. One change is in regard to better defining qualifying patients. With new changes, patients must have in-person medical visits with a 340b covered entity to qualify. Another example of a potential change is with manufacturers. Before any changes, the HRSA did not have the power to audit manufacturers and ensure they were proving drugs to covered entities at a discounted price. With the changes, the HRSA would be given the power to both audit manufacturers as well as impose penalties on those who do not comply with 340b regulations. These changes, when implemented, will improve 340b but more is needed for 340b to achieve its original goal of spreading federal resources to the underprivileged.

Robert Bond, PharmD '18

Policies to Help Stabilize Rising Drug Costs

In the last blog I reviewed drug pricing terminology between the wholesaler and pharmacies. In this blog I will review how this process can lead to increasing drug costs. I will also two discuss public policies that have been implemented to try to stabilize that trend.

As mentioned previously, pharmacies are reimbursed at a discounted Average Wholesale Price (AWP). Pharmacies can seek deals with wholesalers to buy drugs at the Wholesale Acquisition Cost, WAC, or Average Manufacturer Price, AMP. Pharmacies will then make a profit by selling at around AWP. In other words, a pharmacy’s profit can be represented as AWP minus either WAC or AMP. Pharmacies can increase their profits by selling drugs with higher AWPs. Knowing this, manufacturers may attempt to set a higher AWP.  Since pharmacies are drawn to higher AWPs and purchase from wholesalers, wholesalers will carry the highest AWP drugs they can to satisfy the pharmacies they sell to. This relationship is similar to that of the manufacturer and the wholesaler. The manufacturer will create the highest AWP possible to attract the wholesalers who are going to buy at lower price like AMP anyway. Because wholesalers do not purchase drugs at AWP, and instead purchase drugs at a lower price, an increase in the AWP will not cause them to search for other manufacturers. This means that manufacturers can increase AWP while simultaneously satisfying the needs of pharmacies, making their product more attractive to wholesalers without losing business to competing manufacturers. AWP has a natural tendency then to increase because pharmacies want it higher and manufacturers can increase it without the risk of losing business from wholesalers.

Increasing AWP does increase costs to insurers and taxpayers. Since the government does serve as an insurer, it has put policies in place to prevent increases in AWP from bankrupting them. The federal government does this by imposing a Federal Upper Limit, FUL. This limit is the maximum price at which Medicaid will reimburse a pharmacy for a drug. In order for a drug to qualify for an FUL price, it must have at least three equivalent products made by three different manufacturers. To put is simply, if “Drug X” had an FUL price, it must have three different therapeutically equivalent generics that are made by at least three competing manufacturers. The FUL prices is set at 150% of the cost for the cheapest equivalent drug. If “Drug X” is made by manufacturers 1, 2 and 3, and the cheapest price is from manufacturer 1 at $100 dollars, then “Drug X”’s FUL price is $150. These strict qualifications means that some drug do not have an FUL price and of those that do, paying 150% for the cheapest generic may not produce any savings. In order to make up for these limitations, some states have created Maximum Allowable Costs or MAC (more information available here). MAC was designed to operate as a continuation of FUL to further increase savings but at a state level. MAC prices are uniquely set by each state and do not have strict rules for establishing what drugs qualify for MAC and what the price ceiling should be. This has created variation between states with some states achieving more drugs that qualify and more aggressive price ceilings than others. Whether or not these MACs were worth the resources put into their creation is something that remains to be seen.

In conclusion, both state and the federal government have created policies to the curb the natural tendency for AWP to rise. The federal government first created the Federal Upper Limit, or FUL, and states later created Maximum Allowable Costs, or MAC based up the FUL. The FUL has severe limitations in the form of drug qualifications that are too strict and a 150% price ceiling that can be ineffective. The MAC on the other hand may be a step in the right direction. Since the MAC is based off of and shares similar limitations to the FUL, its effectiveness remains to be seen. Moreover, while FUL and MAC may be effective in some situations, they alone are not enough to prevent increasing drug costs.

Robert Bond, PharmD '18



PCP Grads Pursue Residency Programs at the Johns Hopkins Hospital

Ekeoha-ijeomaSoon after Ijeoma Ekeocha PharmD'09 graduated from University of the Sciences in 2009, she followed her dream career as a pharmacist at Johns Hopkins Hospital in Baltimore

During her time as a hospital pharmacist, Dr. Ekeocha became particularly interested in emergency medicine, internal medicine, diabetes management, patient education, and academia. After five years in that role, Dr. Ekeocha recently made the decision to expand her knowledge and education in the field and became a pharmacy practice resident at Johns Hopkins Hospital earlier this year. She plans to continue her training with a second year specialty residency.

Dr. Ekeocha said she is thankful to the hospital’s pharmacy department for providing her with a unique opportunity that will help her achieve her goal of becoming a clinical faculty member at a large academic institution.

Tolan-meghanRecent graduate Meghan E. Tolan PharmD’14 is also wrapping up a two-year health-system pharmacy administration residency at Johns Hopkins. This competitive program also gave her a chance to pursue an MBA in healthcare management at the Johns Hopkins Carey Business School.

Dr. Tolan’s professional interests, include quality improvement, regulatory affairs, clinical and operational management, transitions of care, academia, and professional pharmacy organizations. She currently serves as the resident member of the American Society of Health-System Pharmacists Commission on Credentialing.


Daraprim – The Ultimate Drug Pricing Outrage?

Drug priceBy Dr. Daniel A. Hussar, the Remington Professor of Pharmacy at University of the Sciences' Philadelphia College of Pharmacy. He serves as the author and editor of The Pharmacist Activist newsletter from which this editorial was taken.

Pyrimethamine (Daraprim) was initially approved in the United States in 1953 for the treatment of patients with malaria. It was subsequently determined to be of value in the treatment of toxoplasmosis, a relatively uncommon but sometimes fatal parasitic infection for which patients with compromised immune systems (e.g., patients with AIDS) are at greatest risk. Pyrimethamine is a component of the regimen that has been considered to be the most effective treatment for toxoplasmosis.

Pyrimethamine was originally developed and marketed by the Burroughs Wellcome Company (subsequently acquired by the company now known as GlaxoSmithKline). Following expiration of its patent, the product and its trade name Daraprim have been acquired and marketed by several other companies. Generic formulations of the drug have either been unavailable or available on only a limited basis because the drug is used so infrequently that generic companies have not considered it commercially feasible to market. As recently as 5 years ago, the cost of Daraprim was about $1 a tablet. The US marketing rights to the drug in the United States were sold by GlaxoSmithKline in 2010, and the rights to the drug have been sold several additional times during the last five years. In the period preceding August, 2015 Daraprim was marketed by Impax Laboratories at a cost of $13.50 a tablet.

Turing Pharmaceuticals

In August, 2015 Impax sold Daraprim to Turing Pharmaceuticals. Shortly prior to that time Impax discontinued distributing the drug through the traditional pharmacy system and restricted its availability to a controlled distribution system, resulting in only very limited supplies of the drug remaining available in general distribution.

The CEO of Turing is a former hedge fund manager and a former CEO of a small pharmaceutical company (Retrophin), another company that acquired an older infrequently prescribed drug (tiopronin [Thiola] for the prevention of cystine kidney stones) that was not available from other sources, and then markedly increased its price.

Following its purchase of Daraprim in what has been described in commentaries as an "overnight" price increase, Turing raised the price of Daraprim from $13.50 a tablet to $750 a tablet. The company and its CEO initially attempted to justify the price increase by describing it as a great business decision that would be of benefit for all of its stakeholders. The previous price was identified as unprofitable and the drug was portrayed as being so infrequently prescribed that the impact of the price increase would be minuscule. The Turing CEO was quoted as saying, "This isn't the greedy drug company trying to gouge patients, it is us trying to stay in business" (New York Times, September 20).


Daraprim is not the first drug for which the availability of an older drug has been limited/restricted/controlled with a resultant sharp increase in its price. Examples include tiopronin, doxycycline, cycloserine, isoproterenol, repository corticotropin injection (H.P. Acthar Gel), and hydroxyprogesterone caproate (Makena). However, the outrage regarding the Daraprim price increase from patients, health professionals, legislators, Presidential candidates, and the public has been immediate and intense. This response is certainly due, in large part, to the huge amount of the price increase, profit being the single motivation for the increase, and the arrogance of the company and its CEO in attempting to justify the increase. This situation has also occurred during a time period in which numerous concerns have been voiced about the prices of many drugs, including important drugs for chronic hepatitis C infection, cholesterol-regulating drugs with a unique mechanism of action, and many anticancer drugs.

The Daraprim experience has become a "lightning rod" that has galvanized attention to all examples and reasons for which many have concerns about drug prices. It has to be the worst nightmare for the Pharmaceutical Research and Manufacturers of America (PhRMA) and the Biotechnology Industry Organization (BIO) that represent the interests of the pharmaceutical companies, and are very concerned that their member companies' motives and actions might be considered to be similar to those demonstrated by Turing. BIO issued the following statement in response to the Daraprim situation:

"Turing Pharmaceuticals was a member of BIO for a brief period of time and is currently no longer a member. The company and its leadership do not reflect the commitment to innovation and values that are at the core of BIO's reputation and mission. For that reason, BIO determined, after a review of Turing's membership status, that the company did not meet our eligibility criteria, and we took action to rescind its membership and return its membership dues."

I commend BIO for taking this action. However, an evaluation of "the commitment to innovation and values" of certain other companies is also warranted. Although the price increase and statements from Turing may be the most blatant and arrogant to date, some other companies are also engaged in similar practices that are motivated only by the anticipation of large profits.

The storm of criticism and anger regarding the price increase for Daraprim resulted in an announcement from Turing several days later that it would lower the price although, at the time this is being written, the reduced price had not yet been identified. Turing also attempted to convey a message that the higher price was needed to fund research regarding toxoplasmosis and the development of educational programs and new drugs from which patients would benefit. It also indicated that the medication would be provided to patients with financial need. However, its singular motivation for high profits had already been exposed, and its belated attempt to claim it was interested in patients only further eroded its credibility.

A better outcome

The antitubercular drug cycloserine was developed in the 1950s but is seldom used in current therapy. However, it is of value in the treatment of patients with potentially life-threatening multi-drug resistant tuberculosis that is resistant to conventional antitubercular regimens. Cycloserine capsules have been supplied by The Chao Center, a nonprofit organization that is part of the Purdue Research Foundation, at a cost of $480 for 30 capsules. It recently sold the product to Rodelis Therapeutics. When it was learned that Rodelis planned to increase the price of cycloserine to $10,800 for 30 capsules, Chao requested that the rights to the drug be returned. The two companies agreed that the sale of the drug would be canceled and the rights to the drug were returned to Chao. Although Chao considers it necessary to raise the price to approximately $1,050 for 30 capsules, this is only about one-tenth of the price Rodelis had planned to charge.

Other options

The Daraprim experience represents an abuse of the drug distribution system and undermining of its already fragile financial viability. These situations must not be tolerated. One strategy is to have the company that initially obtained approval for the drug or a generic pharmaceutical company supply the drug at a low profit margin. The situation described above in which cycloserine is supplied by a nonprofit organization is a variation of this approach.

Another option is to have compounding pharmacists obtain the medication and prepare the appropriate dosage forms. Although there are restrictions with respect to pharmacists compounding formulations that are commercially available, this situation needs to be reconsidered and exceptions to the restrictions explored.

Another option is to obtain certain medications from a Canadian pharmacy. I have not been an advocate for US residents obtaining medications from Canada and other countries. However, it is my understanding that pyrimethamine tablets cost between $6 and $7 each from a Canadian pharmacy, compared to $750 that Turing was planning to charge in the US. This difference can't be justified and current restrictions must be reconsidered.

The concerns about the prices for new drugs and other drugs that still have patent protection are complex and beyond the scope of this commentary. However, for older drugs for which the patents have expired, the options identified above should be actively pursued to prevent greedy profiteers from exploiting the drug distribution system by restricting availability and charging astronomical prices. Pharmacists, other health professionals, and patient groups must work with legislators and the Food and Drug Administration to remove restrictions that currently limit the extent to which affordable medications can be provided for patients.


Lifestyle Factors Could Put College-Age Women at Higher Risk of Breast Cancer, Says USciences Prof

IMercier_250x350Breast cancer prevention needs to become a shared conversation among women of all ages because it can strike at any age and is generally more aggressive when diagnosed in women under the age of 50, said Isabelle Mercier, PhD, a pharmaceutical sciences professor at University of the Sciences. With hopes to spark that discussion, Dr. Mercier compiled some key prevention awareness tips for young women.

“Unfortunately, college-age women generally do not consider themselves at risk for breast cancer,” said Dr. Mercier. “However, there are several risk factors that contribute to the development of breast cancer that need to be understood early in life to prevent the development of breast cancer down the road.”

By the end of 2015, more than 231,000 new cases of invasive breast cancer are expected to be diagnosed in the U.S. Of those cases, approximately 40,000 individuals will not survive, said Dr. Mercier. Women in their early 20s need to become aware of some key risk factors associated with breast cancer:

  • Check your family tree. A family history of breast cancer, particularly in a mother or sister, can increase the chance for developing breast cancer. Genetic testing is recommended for young women with prevalence of breast cancer in their families.
  • Watch your weight. Obesity is responsible for up to 20 percent of cancer-associated deaths in women. Being overweight or obese increases the risk of breast cancer by creating a cancer-friendly environment through fat cells.
  • Exercise regularly. Women who strive for at least 2.5 hours per week of moderate-intensity activity – like brisk walking – reduce their risk of breast cancer by 18 percent.
  • Limit alcohol consumption. According to research from Washington University School of Medicine, if a female averages a drink per day, her risk of breast cancer increases by 11 percent. Studies show that alcohol possesses estrogenic activity, thus promoting the growth of breast tumor cells.
  • Annual doc visits. Although mammograms are not recommended for women under the age of 40, young women should still see their primary care doctors each year for clinical breast exams. They are also encouraged to conduct self-examinations throughout the year.
  • Limit tobacco use. Women who smoke have an increased risk of developing breast cancer, especially if they become smokers early in life. Smokers have increased levels of both estrogen and testosterone that might disrupt the endocrine signaling in women and contribute to the development of these tumors.

An important part of Dr. Mercier's research focuses on cancer prevention. The role of vitamin C intake on breast cancer development, progression, recurrence and response to anti-cancer therapy remains unclear. That’s why Dr. Mercier and her research team at USciences are currently studying the role of dietary supplements on cancer risk, as well as evaluating new biomarkers for early detection of breast cancer. 

Media exposure:

KywOct. 8, 2015
Healthy College Lifestyles Can Help Women Prevent Breast Cancer

Breast cancer is rare among college-age women, but lifestyle choices made during those years can be life-saving years later.


Alum's Pharmacy Nationally Recognized for its Service to Community

HealthMart_Tepper_093015Pharmacy alumnus Craig Lehrman P’89, a second-generation pharmacist who learned the business from his father, was recently honored for consistently providing care and services that add measurable value to patient healthcare and community wellness. His independently-owned Tepper Pharmacy, located in Wynnewood, Pa., is one of 10 pharmacies across the country to receive the Health Mart Community Healthcare Excellence Award.

After graduating from Philadelphia College of Pharmacy in 1989, Lehrman gained most of his pharmacy experience working for others before he achieved his goal of owning a pharmacy in 2011. Over the past four years, Lehrman and his staff have continued to build upon Tepper Pharmacy’s rich 30-year history of delivering personalized care to the community.

“I was interested in the business aspect of pharmacy, but it was my father that guided me into the profession of pharmacy,” he said. “I was looking for a store to buy and even considered opening a new store from scratch, until the perfect opportunity arose to take over Tepper Pharmacy.”

In this new era of chain pharmacies and mail order prescriptions, one of the hallmarks of independent pharmacies, like Tepper, is their ability to understand and cater to the unique needs of their community.

“I want the service that we provide to make us unique,” Lehrman said. “The personal interactions we have with our customers is what makes us stand out and it is an important part of what makes Tepper Pharmacy a successful business.”

Beyond the traditional services most pharmacies offer, Tepper Pharmacy’s staff includes an employee who specializes in fittings for compression stockings and sleeves and is also an expert in durable medical equipment and wound care, a pharmacist who specializes in managing the medications for long-term care facilities in the area, and a pharmacy team that services local dialysis centers.

To help the community stay healthy, Tepper Pharmacy administers vaccinations, offers free delivery anywhere in the Philadelphia metropolitan area, and makes every attempt to fill all prescriptions by stocking a large inventory. These specialized and personalized services are just a few examples that exemplify the concern Lehrman and his pharmacy staff have for the community.

The Health Mart Community Healthcare Excellence Award program is a component of the Health Mart Healthy Living Tour, which is on the road to celebrate and recognize community pharmacists for the important role they play as trusted healthcare providers in their communities—helping to educate and counsel on a variety of conditions that can be better managed with the help of a pharmacist.  

“Health Mart pharmacies fill a gap in today’s busy healthcare system by providing broader access to clinical services and medication counseling, and our pharmacists often serve as the first point of care for everyone from new parents to grandparents,” said Chuck Wilson, vice president of Health Mart. “We recognize that issues like diabetes and obesity are serious epidemic affecting millions of Americans, and these 10 pharmacists have proven themselves as go-to resources for those in their community managing these diseases.”

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