Frequently Asked Questions

Following are answers to frequently asked questions regarding this data sharing project. Question categories include information sharing, board investigations, pharmacy participation, project audits, and Food and Drug Administration’s (FDA’s) memorandum of understanding (MOU). Refer to FDA’s frequently asked questions about the MOU for more information. If you have any additional questions, see the Compounding Pharmacy Information Sharing Project overview page or contact prof-affairs@nabp.pharmacy.

Information Sharing

What information will be provided to FDA through the Information Sharing Network developed by NABP?

Upon approval by a board of pharmacy, the system will provide FDA with:

*“Inordinate amount” refers to the number of prescription orders for compounded drug products distributed interstate that is greater than 50% of the number of prescription orders for compounded drug products distributed or dispensed both intrastate and interstate by such compounder. 

What specific information will boards of pharmacy submit to the Information Sharing Network about compounding pharmacy complaints?

Regarding complaints relating to human drug products compounded by a pharmacy and distributed outside a state, boards of pharmacy will submit the following information:

*The FDA considers this information not available if the state prohibits the release of this information.

**Provide to FDA after the board concludes its investigation of the complaint.

How quickly must a board of pharmacy submit complaint information to FDA?

The MOU requires boards of pharmacy to submit information about a serious adverse drug experience or serious product quality issue relating to a drug product compounded at a pharmacy and distributed interstate no later than five business days after receiving the complaint.

It may take time for the board to obtain enough information to determine whether the complaint is serious. The five-day time period begins after the board discovers the complaint is serious.

What specific information will boards of pharmacy submit to the Information Sharing Network about compounding physician complaints and notifications?

Regarding complaints relating to human drug products compounded by a physician, or regarding the distribution of any amount of human drug products compounded by a physician and distributed outside a state, boards of pharmacy will submit the following information, if available:

How quickly must a board of pharmacy submit physician complaint information to  FDA? 

The MOU requires a board of pharmacy to submit physician complaint information to FDA as soon as possible, but no later than five business days after receiving the complaint. The MOU requires a board of pharmacy to submit information about the interstate distribution of any amount of drugs compounded by a physician no later than 30 business days after becoming aware of such distribution. In addition, the board must notify the state regulator of physicians. 

Where can board of pharmacy staff find instruction for submitting data to the Information Sharing Network? 

Board of pharmacy staff who have been approved to have access to NABP e-Profile Connect may log in via the e-Profile log in link on the NABP website. Once they are logged in to e-Profile Connect, they can access a training video via the Help link in the upper right corner of the screen. Look for the video link called “Understanding the FDA MOU Information Sharing Network.” 

Board Investigations

What types of complaints does the MOU obligate the board of pharmacy to investigate?

The board of pharmacy or state agency will investigate complaints of adverse drug experiences* and product quality issues** relating to human drug products compounded at a pharmacy in that state and distributed outside the state.

*An adverse drug experience is any adverse event associated with the use of a drug in humans, whether or not considered drug related, including the following: an adverse event occurring in the course of the use of a drug product in professional practice; an adverse event occurring from drug overdose, whether accidental or intentional; an adverse event occurring from drug abuse; an adverse event occurring from drug withdrawal; and any failure of expected pharmacological action (21 CFR 310.305(b)). 

**A product quality issue is information concerning (1) any incident that causes the drug product or its labeling to be mistaken for, or applied to, another article; or (2) any bacteriological contamination; any significant chemical, physical, or other change or deterioration in the distributed drug product; or any failure of one or more distributed batches of the drug product to meet the applicable specifications (21 CFR 314.81(b)(1)). Contamination in general, including but not limited to mold, fungal, bacterial, or particulate contamination, is a product quality issue.

What are the standards for complaint investigations? 

Any investigations will be performed pursuant to the board of pharmacy or state agency’s established investigatory policies and procedures, including those related to prioritizing complaints, provided they are not in conflict with the terms of the MOU.

For example, using established procedures, a state board of pharmacy or other appropriate state agency may review an incoming complaint describing an adverse drug experience and determine the complaint does not warrant further investigation. In other cases, a state board of pharmacy or other appropriate state agency may determine that an incoming complaint contains insufficient information and investigate further to determine appropriate action.

Any investigations performed by the board of pharmacy or state agency under the MOU will include taking steps to assess (1) whether there is a public health risk associated with the compounded drug product; and (2) whether any public health risk associated with the product is adequately contained.

There is no obligation for the board of pharmacy to investigate complaints regarding compounding physicians. 

The MOU requires the board to report a variety of information within a certain number of business days after receipt. When does that timeline begin in a situation where the umbrella agency, rather than the board, receives the information initially?  

The timeline begins when the agency that signs the MOU, be it the umbrella agency or the board, receives the information.

Pharmacy Participation

What incentives are in place for a pharmacy to voluntarily enter the requested information?

The information requested in the MOU is incorporated into the application for many NABP accreditation and inspection programs, including Verified Pharmacy Program (VPP). All applicants seeking accreditation or a VPP inspection will voluntarily submit the requested information – regardless of whether their primary intent is to participate in the pilot project.  

During the pilot project, compounding pharmacies also can enter the requested information, outside of the accreditation or VPP application process, for a chance to receive a VPP inspection at no cost to them. The VPP inspection in this scenario will be adapted to serve the dual purpose of a traditional blueprint inspection and an audit for the pilot project. If pharmacies that submit the requested information through the NABP program application are chosen for an audit, they will receive either a refund or a future VPP inspection at no cost to them. 

After the pilot project, VPP will no longer be available free of charge. 

Under the pilot project, what will NABP do with the information that the pharmacies provide?

NABP will consult with FDA to select 150 eligible pharmacies to be audited for the project. The pharmacies will be prioritized based on factors including the volume of compounded drug products distributed interstate and other considerations. Those selected to be audited will receive a VPP inspection developed for entities engaged in sterile compounding. These VPP inspections will be modified to gather the additional information needed for the project. NABP will engage its team of seasoned and knowledgeable surveyors to conduct the audits, after providing them with the appropriate training to gather the necessary information.

Where can compounding pharmacies find more information about submitting the requested data?

The Help section of the NABP website has several FAQs to provide pharmacies a basic understanding of the compounding pharmacy information sharing project, the data being collected, and how they can submit data via the NABP business e-Profile.

Project Audits

How will NABP determine which pharmacies to audit?

NABP will select pharmacies for audits by consulting with FDA and prioritizing pharmacies based on several factors, including the volume of compounded drug products distributed interstate. 

What will the audits entail?

The audits will, among other things, assess the accuracy of the information provided, including the total number of prescription orders for compounded drug products distributed interstate and distributed or dispensed intrastate, and whether the pharmacy distributes compounded drugs without patient-specific prescriptions, such as for office stock. Audits also will evaluate the compounding facility for issues such as those related to production quality.

What will NABP do with the audit findings?

NABP will conduct research to analyze the information that the pharmacies self-reported in the data system, as compared with the audit findings. The analysis will assess the quality and reliability of the data collected in the system. This research will provide the following information:

FDA MOU

Can states now sign the MOU and, if so, have any states done so?

The final MOU was released in October 2020; therefore, states can now sign. See the MOU participation map for the latest updates.

What should a state do if it would like to sign the MOU? 

States with interest in entering the MOU should email compounding@fda.hhs.gov

After signing the MOU, when are boards of pharmacy expected to start sharing inordinate amount data with FDA?  

The expected start date for sharing inordinate amount data may vary based on when the state signs the MOU. The calculation of inordinate amounts is based on data from a calendar year, and states may be signing the MOU at different times in the middle of a calendar year.

States are invited to communicate with FDA regarding their individual circumstances and start date for sharing data. FDA intends to work with the states that sign the MOU as they phase in the annual identification and calendar-year-based calculations of inordinate amounts.

Can the state solely rely on pharmacies entering information into the Information Sharing Network to identify pharmacies that distribute inordinate amounts of compounded human drug products interstate under the MOU?

By signing the MOU, the state is agreeing to identify pharmacies that distribute inordinate amounts of compounded drugs interstate. However, the MOU provides flexibility in how the state does this, including use of tools like NABP’s Information Sharing Network. If a state that chooses to use the Information Sharing Network is uncertain whether the information it contains is complete, the state may verify information through other means, such as during inspections. FDA will continue to work with states to address questions regarding reporting expectations under the MOU.

What will FDA do with information submitted by the states under the MOU?

Protecting patients is FDA’s top priority. Information submitted by the states will help inform FDA about potential for patient harm, including whether additional federal oversight is warranted. The information submitted by the states also will help inform the agency’s risk-based inspection priorities.

When will FDA be enforcing the 5% rule?

FDA announced on August 6, 2021 that enforcement of the 5% rule will begin two years after the release date of the MOU, in October 2022. At that time, FDA will begin enforcing the 5% limitation on interstate distribution of compounded human drugs by pharmacies in states that have not signed the MOU.

What impact will the recent US District Court ruling about the MOU have on NABP e-Profile and the Information Sharing Network?

NABP will continue to operate e-Profile and the Information Sharing Network.

What if a board that signs the MOU does not or cannot comply with the MOU?

There are no penalties associated with noncompliance; however, FDA may move forward with terminating the MOU following a 60-calendar-day notice, which will result in enforcement of the 5% limitation on interstate distribution of compounded human drugs by pharmacies.

Will boards have an opportunity to negotiate the language of the MOU?

No, FDA has made the standard MOU available for signature. Section 503A of the FD&C Act directs FDA to develop, in consultation with NABP, a standard MOU for use by states. Developing individualized MOUs would create a patchwork of regulation of distribution of compounded drugs interstate and it would be impractical to have individual MOUs with each state.

Can a state that is prohibited by a state law from disclosing a complainant’s name and contact information fulfill the agreed upon data reporting under the MOU?

Yes. Under the MOU, the state is agreeing to report the name and contact information of the complainant, if available, to FDA. If providing this information is prohibited by state law, FDA does not consider it to be “available” for purposes of the MOU. In addition, NABP’s Information Sharing Network will allow boards to select whether to make this information accessible to other boards.

Model Language for States

Does NABP have model language for states that intend to require all human drug compounders to report data to the Information Sharing Network?

Yes, the Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy(ModelAct) provides the following language:  

Model Rules for Compounded or Repackaged Pharmaceuticals  

  

Section 2. Notification.   

Does NABP have model language for states that intend to require only compounders who ship human drugs interstate to report to the Information Sharing Network?  

Yes, the model language for this circumstance is provided below (not in the Model Act):  

On an annual basis, and within 90 days of the beginning of the calendar year, all licensed Persons who ship compounded human drug products interstate shall report to the NABP Information Sharing Network the information required by the “MEMORANDUM OF UNDERSTANDING ADDRESSING CERTAIN DISTRIBUTIONS OF COMPOUNDED HUMAN DRUG PRODUCTS BETWEEN THE [insert STATE BOARD OF PHARMACY OR OTHER APPROPRIATE STATE AGENCY] AND THE U.S. FOOD AND DRUG ADMINISTRATION.”  

Does “prescription order” in the MOU include new and refill prescription orders? 

Yes. As stated in the September 10, 2018,  Federal Register Notice  proposing this MOU, “For purposes of this MOU, each refill is considered to be a new prescription order.” 

What compounded drug products are not covered by the MOU? 

Such products include: