A behind-the-scenes dispute over a regulatory memorandum threatens to scramble long-running efforts to bolster oversight of compounding pharmacies, a concern that has haunted government officials ever since an outbreak of fungal meningitis killed dozens of people seven years ago.

At issue is an attempt by the Food and Drug Administration to sort out responsibilities with the states for monitoring inordinate amounts of medicines shipped by two different types of compounders — those making large quantities and smaller pharmacies that dispense medicines for individual patients. The distinction was created as part of a federal law in 2013 in response to the fatal outbreak.

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