In response to the growing U.S. meningitis crisis, the National Association of Boards of Pharmacy (NABP) has issued a national action plan to help individual states bolster their regulation of nontraditional compounding pharmacies like the New England Compounding Center, or NECC, the Massachusetts-based company whose compounded methylprednisolone product has so far been linked to more than 400 fungal meningitis cases and 34 deaths nationwide.

The release of the NABP action plan on Tuesday came a day after the U.S. Senate Committee on Health, Education, Labor and Pensions, or HELP, sent a letter to all 50 state boards of pharmacy seeking details of how they oversee the nation’s more than 3,000 compounding pharmacies. The letter was part of the committee’s investigation into how the outbreak occurred and what legislative actions could reduce the risk of future occurrences.

Carmen Catizone, MS, RPh, DPh, executive director of NABP, told Pharmacy Practice News that “a number of states have asked us to represent them and coordinate of their activities” relating to the congressional inquiries and how the state boards might respond to the crisis.

As an example, he said, “Iowa has contracted with us to inspect all 582 of their nonresident pharmacies. They are identifying how many of those are traditional sterile and nonsterile compounding pharmacies and how many are nontraditional (like NECC), which is the problem area that we’re going to focus on.”

Dr. Catizone said NABP was sending Iowa’s list to all states and asking them to supplement the information by stating if the pharmacies exist, if they are compounding and if they are involved in nontraditional compounding activities—meaning the wider distribution of compounded products to multiple users, rather than in response to individual prescriptions.

After the pharmacy list is fine-tuned, Dr. Catizone said NABP will “physically inspect all those pharmacies and update them in our database, creating profiles for new pharmacies that we find, and then make that information available [in special reports] that our public and the states can share.”

He said NABP has the staff resources to carry out the inspections. “Last year we accredited 30,000 pharmacies for the CMS [Centers for Medicare & Medicaid Services] Durable Medical Equipment program, so we have field staff as well as in-house staff to review documents and special reports, policies, procedures, all those things. So we’re geared up, and it’s going to start in December.“

But additional support will be needed, Mr. Catizone added, including training for inspectors and staff on the new requirements. “What’s going to have to happen,” he said, “is a public-private partnership with groups like NABP, where we actually do the inspections or assist the states in doing inspections and then the pharmacies pay fees to these private organizations for that work.”

Dr. Catizone said he is dismayed that this public health crisis occurred in the first place. “This was a system failure,” he said. “Unfortunately they’re blaming certain individuals in Massachusetts. It wasn’t one or two individuals’ responsibility, it was the entire system that failed.”