MASSACHUSETTS: PUBLIC HEALTH OFFICIALS OPPOSE BILL

      Officials for the Massachusetts Department of Public Health
 testified yesterday against a proposed bill that would create a
 list of special drugs that require "approval of a doctor and
 pharmacist" before a generic version of a drug "could be
 dispensed," BOSTON GLOBE reports.  DuPont Merck Pharmaceuticals
 Inc., the sole manufacturer of Coumadin, filed the legislation
 after the FDA approved in March a generic version of the drug by
 Barr Laboratories Inc.  Coumadin is classified as a "narrow
 therapeutic index" drug, meaning that it requires close
 monitoring.  Barr officials contend that their drug "meets all
 the FDA requirements -- same active ingredient, identical in
 strength, dosage form and labeling as Coumadin -- and provides
 the same therapeutic benefit."  
      ARGUMENTS:  According to Nancy Ridley, assistant
 commissioner for the bureau of health quality management at the
 Department of Public Health, the state "already has the authority
 to review all drugs for public safety."  The state's 20-year-old
 Drug Formulary Commission reviews drugs, and can pull a drug off
 the market in Massachusetts if the drug does not meet "state
 safety and health requirements."  Ridley said, "I just don't see
 the need for this legislation.  We already have regulations
 requiring close communication between physician, patient and
 pharmacy."  However, GLOBE reports that supporters of the bill
 maintain that the substitution of narrow therapeutic index drugs
 should be given special attention because they "require such
 careful patient monitoring."  Although DuPont Merck has filed
 similar legislation in "nearly a dozen other states," only North
 Carolina has passed a bill requiring a narrow therapeutic index
 drug list; and California legislators rejected the proposal last
 week (see AHL 5/16) (Rosenberg, 5/21).