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doi: 10.1016/j.abb.2016.08.005

Instead, compounding pharmacies produce these medications under state pharmacy board regulation when the commercially available product is either unavailable or when a prescriber determines a clinically significant difference exists for the patient

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Comment: Several commenters stated that it is unreasonable for CMS to apply the efficiency adjustment, essentially a productivity adjustment, to reduce PFS payments when there is no corresponding market basket or inflationary adjustment to increase PFS payments annually

They concluded that silymarin is safe and effective as an herbal galactagogue, capable of boosting lactation without affecting breast milk quality.20 We should mention that some sources say to avoid using milk thistle while breastfeeding, as one can't conclusively attest to its safety for either the mother or the infant based on the current research