BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 1045
                                                                  Page  1

          Date of Hearing:   May 15, 2013

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS
                                  Mike Gatto, Chair

                 AB 1045 (Quirk-Silva) - As Amended:  April 22, 2013 

          Policy Committee:                              Business,  
          Professions and Consumer Protection           Vote: 13-0

          Urgency:     No                   State Mandated Local Program:  
          Yes    Reimbursable:              No

           SUMMARY  

          This bill requires patients to be notified within 24 hours of a  
          recall notice for a sterile compounded drug, and requires the  
          automatic suspension or revocation of a nonresident pharmacy  
          license in this state if the nonresident pharmacy's home state  
          license is suspended or revoked.
           
          FISCAL EFFECT  

          Minor and absorbable costs to the Board of Pharmacy (BOP).

           COMMENTS  

           1)Rationale  . This bill addresses gaps noted in existing federal  
            and state pharmacy regulation after a nationwide meningitis  
            outbreak killing 47 people was traced back to problems with a  
            Massachusetts compounding pharmacy.  The Massachusetts  
            pharmacy's California license could not be revoked immediately  
            under existing law.

           2)Background  . A compounding pharmacy is a licensed pharmacy that  
            prepares, alters or combines drugs or drug ingredients by or  
            under the supervision of a licensed pharmacist pursuant to a  
            prescription. There are 286 licensed sterile injectable  
            compounding pharmacies in California and 93 nonresident  
            licensed sterile injectable compounding pharmacies that ship  
            to the state.

            Sterile compounding is a specific sub-type of general  
            compounding in which the compounded drug product is sterile.  
            These products are often placed directly into the body through  








                                                                  AB 1045
                                                                  Page  2

            injection, via eye drops, or inhaled; these drugs must be  
            produced in the most sanitary, regulated environments and be  
            absolutely sterile to avoid infection.

            Compounding pharmacies have been compounding greater volumes  
            of sterile drugs in recent years because these pharmacies are  
            increasingly requested by hospitals and health care providers  
            to help address drug shortages. According to the federal Food  
            and Drug Administration (FDA), there has been an almost 500%  
            increase in manufactured drug shortages since 2006, the  
            majority of which are for critical, medically necessary,  
            generic sterile injectable drugs.

            In September 2012, the New England Compounding Center (NECC),  
            a compounding pharmacy in Massachusetts, was found to be  
            responsible for 47 meningitis deaths across 19 states due to  
            its sale of a contaminated injectable steroid. That pharmacy  
            was primarily regulated by the Massachusetts Board of  
            Pharmacy, with concurrent authority by the FDA. NECC  
            surrendered its license to the Massachusetts Board of  
            Pharmacy, but BOP lacked authority to immediately revoke  
            NECC's license.

           3)Related legislation  .  SB 294 (Emmerson) eliminates the  
            exemption from BOP inspection for accredited sterile  
            compounding pharmacies, including nonresident pharmacies, and  
            requires nonresident sterile compounding pharmacies to pay  
            appropriate travel expenses for staff. It also requires  
            sterile compounding pharmacies to report additional safety  
            information to BOP and requires pharmacies to report any  
            adverse effects due to a pharmacy's sterile drug product to  
            the FDA's MedWatch program. SB 294 is currently pending on the  
            Senate Appropriations Committee Suspense File.

           Analysis Prepared by  :    Debra Roth / APPR. / (916) 319-2081