[Pharmwaste] CMS adopts rule to encourage trial prescriptions
zenllc at usfamily.net
Thu Apr 12 13:32:17 EDT 2012
It looks as if we did it! CMS has adopted rules, effective either June or
Jan. 1 to encourage trial prescriptions by providing a pro-rated co-pay.
Here's the link to the Federal Register notice,
http://www.gpo.gov/fdsys/pkg/FR-2012-04-12/html/2012-8071.htm. See pp
Very truly yours,
Catherine Zimmer, MS, BSMT
Industry Leader, Caring for the Environment
PSC Healthcare Services
catherine.zimmer at pscnow.com
From: Tenace, Laurie
Sent: Thursday, March 29, 2012 8:35 AM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] MN setting helath standard for some "contaminents of
ST. PAUL, Minn. - The Minnesota Department of Health is taking a closer look
at a variety of chemicals that make their way into the water supply.
Federal and state regulators have already placed limits on many contaminants
found in drinking water, among them lead and mercury. But health officials
are turning their attention to other chemicals that are not widely known,
including those in fragrances, prescription drugs and bug spray.
Scientists know that many of them are a problem, but determining when they
become a public health threat is the next step, said Deb Swackhamer, an
environmental chemist at the University of Minnesota.
"We don't have the actual detailed toxicological data that says this
compound at this dose causes this problem so we're going to regulate it at
that dose," said Swackhamer, chairman of the Environmental Protection
Agency's Science Advisory Board. "That kind of data takes an enormous amount
of effort; it takes millions of dollars to collect."
Health department scientists aren't doing any of their own testing. Instead,
using $1.7 million dollars from the state's Legacy Amendment, they're poring
over all the data they can find. Based on existing studies, they'll decide
what amount of various contaminants presents too much risk to be in
Minnesotans' drinking water.
Another challenge Swackhamer said, is persuading the public to care when
most of the substances have little or no immediate effect.
"That's what's so hard to communicate to people," she said. "If you take a
glass of water and get hives, you know you shouldn't be drinking that water,
but in this case you're taking in the water and you have to be thinking
about literally the next generation."
Nancy Brown is one parent who does care. She's gone a lot farther than most
to eliminate potentially toxic products from her family's Minneapolis
apartment. All of the food she feeds her three sons is organic.
Brown also cares about the packaging the family's food comes in. After
reading about some chemicals found in the cling plastic wrap grocery store
delis often use, she asked her local co-op to wrap her cheese in butcher
At home, Brown avoids plastic water bottles and food containers, and uses
"I haven't heated anything in plastic for years," she said.
Brown said plastic can contain chemicals like bisphenol A, or BPA, which is
found in some water bottles and the rubbery lining in food cans. Studies
have shown the chemical is an endocrine disrupter that can interfere with
the body's natural hormones. A new state law bans BPA in baby bottles and
children's sippy cups.
But Brown said there is no way to eliminate all the potential hazards, and
she admits her water faucet is one place where the risk is unknown.
"We drink tap water," she said. "I have no doubt that there's contaminants
we're drinking in our water."
Brown looked into a filtering system called reverse osmosis. But it's
expensive and uses a lot of water.
"It could be a full time job - protecting your children from toxins - and I
don't think any of us should have to do that job," she said. "We just need
better water for everybody."
Brown is on the board of Preventing Harm Minnesota, a group that aims to
reduce toxins children are exposed to. The group nominated BPA for further
study by the health department.
So far, the contaminants of emerging concern program has developed guidance
for 10 different contaminants, including a fragrance, a disinfectant and a
flame retardant. Health officials have also issued recommendations on
acetaminophen, which is in Tylenol, and an anticonvulsant prescription drug.
This year BPA is on the list, along with several types of phthalates, which
are also found in plastics.
Michele Ross, who coordinates the contaminants of emerging concern program,
said it's sometimes difficult for the public to understand why some
substances are being considered harmful.
"Especially with a chemical like a pharmaceutical where it's beneficial,
obviously to whoever's taking it, who's being prescribed it, they need to
take it. The amount that we're finding in water is so much lower than what
you would take if you were actually prescribed it," she said. "But then
again it goes back to that, well I'm not prescribed it, so how does it
Environmental toxicologist Pam Shubat, who supervises the state health
department's health risk assessment program, said guidance for some
chemicals wouldn't exist without Minnesota's work.
"We know how important it is to develop guidance when we can't rely on
guidance from the federal government or guidance from other states," Shubat
The health department was doing some work even before receiving money from
the Legacy Amendment. For example, health officials came up with guidance on
perfluorinated chemicals, or PFCs, which were being found in drinking water
in the east metro area.
"This is such a basic question that whether or not they turn out to be
harmful, most people understand that we do need to have an answer," Shubat
said. "People are going to drink this contaminant. We do need to answer the
As water testing becomes more sophisticated, health officials will be able
to use their research results to limit our exposure to contaminants in the
Ten contaminants for which the MDH has developed guidance:
Minnesota's Legacy Amendment has allowed the Minnesota Department of Health
to create a program looking at what they call contaminants of emerging
concern. The program has received about $1.7 million so far.
In the next couple of years, health officials plan to look at bisphenol A
(BPA), which is found in some water bottles and the rubber lining in food
cans, as well as phthalates, which are found in plastics. Below is the list
of the 10 contaminants for which the health department has issued guidance
as part of the program.
Acetaminophen: A pain and fever medication, most commonly found in Tylenol.
It's been found in Minnesota waters, but at much lower concentrations than
the maximum recommended by Minnesota health officials.
AHTN or Tonalide: A musky fragrance found in personal care and cleaning
products. It's been found in Minnesota waters, but at much lower
concentrations than the maximum recommended by Minnesota health officials.
Carbamazepine: A medication used to help control seizures. It's been found
in Minnesota waters (not drinking water) at lower concentrations than the
maximum recommended by Minnesota health officials.
DEET: An ingredient in many insect repellents. It's been found in Minnesota
drinking water but at a concentration 3,000 times less than the maximum
concentration recommended by Minnesota health officials.
1,4-Dioxane: Found in personal care and cleaning products. It's been found
in Minnesota groundwater at higher concentrations than health officials
recommend, but they say they expect the contaminant would be present in much
lower concentrations in drinking water.
Metribuzin Degradates: Metribuzin is an herbicide used to control weeds in
potato, corn and soybean production. It's been found in Minnesota waters at
lower concentrations than recommended for drinking water.
Pyraclostrobin: A pesticide used to prevent the growth of fungi. It wasn't
found in surface water or groundwater during a recent Minnesota Department
of Agriculture study.
Tris(2-Chloroethyl)phosphate (TCEP): A fire retardant added to plastics,
foams and textiles. It's been found in drinking water but at concentrations
80 times lower than the maximum recommended by Minnesota health officials.
1,2,3-Trichloropropane (1,2,3-TCP): A chemical once used in pesticides
that's also used to make other chemicals. It's been found in Minnesota
waters above health officials' recommended concentration level (a closed
landfill site) but better monitoring techniques would be needed to detect in
Triclosan: An antimicrobial agent added to soaps and cleaners. It's been
found in Minnesota waters at low concentrations but has not been found in
drinking water or groundwater.
Source: Minnesota Department of Health Contaminants of Emerging Concern
Environmental Specialist III
Waste Reduction Section
Florida Department of Environmental Protection
2600 Blair Stone Rd., MS 4555
Tallahassee FL 32399-2400
Laurie.Tenace at dep.state.fl.us
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