On January 1st 2014, oral prescription acetaminophen combination products containing more than 325mg of acetaminophen per oral dosage unit will be taken off the market. This includes products such as brand and generic hydrocodone and acetaminophen tablets 5-500, 5-750, 7.5-750, 10-650 or any other strength containing more than 325mg of acetaminophen. As noted in previous Medixfacts newsletters, this phase out was initiated by the FDA in 2011. The FDA took this action because of continuing reports of severe liver toxicity following the ingestion of excessive amounts of acetaminophen. Excessive acetaminophen ingestion can result in severe liver toxicity leading to liver failure, liver transplant and death. The greatest risk of toxicity occurs in patients taking multiple acetaminophen-containing products (frequently unknown by the patient) and who are also consuming alcohol.

The FDA believes limiting the amount of acetaminophen to 325mg or less in each oral dosage form will NOT reduce the analgesic effectiveness of these combination prescription products but WILL reduce the risk of acetaminophen overdose. The per tablet limit on acetaminophen will not affect how many tablets can be prescribed or the dosage regimen. However, it is strongly recommended that a maximum daily dose of acetaminophen should NOT exceed 4000mg. Effective July 1st, 2013, Pharmedix® will be begin switching clients to the newer lower dose Acetaminophen-Hydrocodone products.

FDA action gainst several generic pharmaceutical companies has lead to shortages and significantly increased prices for the following products; ceftriaxone powder for injection, chloroxazone, ciclopirox, dicyclomine, fluconazole, ondansetron, and ranitidine. Many Hospira products stll remain in short supply. Unrelated to regulatory action, cimetidine, cyclobenzaprine, and guiatuss AC syrup are also expected to dramtically increase in price. As we did with doxycycline, Pharmedix® has secured large stocks of ceftrixone, cyclobenzaprine and ranitidine which should give us ample supplies lasting into 2014. Unfortunately, we were only able to secure a modest supply of fluconazole and ondansteron which means prices will rise by mid fall. The topical and ophthalmic generic companies are also raising prices again. Sulfacetamide 10% Ophthalmic Solution will be over $50 once our current stock is exhausted. The pricing trend appears to be the result of brand companies buying up generic companies and running them like brand companies. For example, Novartis bought Falcon pharmaceuticals, 1 of 2 major generic ophthalmic companies, while the other, Bausch and Lomb has just been purchased by Valent Pharmaceuticals. Fougera of Melville, New York was an old generic company specializing in topical and ophthalmic ointments. However, ever since Sandoz Pharmaceuticals purchased Fougera last year, prices on many of their products have skyrocketed (e.g. Nystatin -Triamcinolone cream cost only 3 to 4 dollars just 2 years ago but now costs nearly $100 for a 15gm tube). The company also dumped their ophthalmic ointment line of products which is why bacitracin and triple antibiotic ophthalmic ointment now cost over $45.00. Federal Trade Commission where are you? There is some good news, isoniazid has come down in price to a level near where it was beforethe huge price increase which resulted from the FDA’s action against Westward. Doxycycline prices have also begun to fall slightly but are still extremely high. Pharmedix® still has stock at the old price for 2-3 more months.

Following recent legal decisions regarding Plan B, Watson has discontinued Next Choice 2-step and will only sell Next Choice One-Step. Contact customer service at 800 486-1811 for our new contract price for this product

Significant cost reductions through negotiated contract pricing will soon be available from Pharmedix®. Pharmedix® already offers significant contract savings on Qualitest Pharmaceutical products, Watson Oral Contraceptives and Next Choice Products However, products from Prasco Pharmaceuticals such as a generic Flonase (Fluticasone) and a generic Malarone both manufactured by Glaxo as well as generic Lotrisone by Schering are also now available from Pharmedix® at new low contract prices. Vivotef from Crucell will be available in July at new contract prices. We are currently under negotiations with Afaxys Pharmaceuticals to supply their Oral Contraceptive Birth Control Pills at significant savings to our clients. We are constantly working with vendors to secure the best possible prices for our clients. Just remember, the more these contract products you purchase the better prices we can secure.

MEDIXFACTS IS A NEWS PUBLICATION OF PHARMEDIX CO. UNION CITY, CA . 1-800-486-1811 www.pharmedixrx.com.