What Is Compounding?
In every field of medicine, there are some patients who don’t respond to traditional methods of treatment. Sometimes they need medicine at strengths that are not manufactured by drug companies, or perhaps they simply need a different method of ingesting a medication.
Pharmaceutical compounding meets these needs. It provides a way for physicians and compounding pharmacists to customize an individualized prescription for the specific need of their patient. From combining multiple medications into a single convenient dosage for hospice patients to delivering children’s cough medicine through a flavored medication, compounding provides solutions not easily met by commercial products.
At Hook's Apothecary, we have aligned ourselves with Professional Compounding Centers of America (PCCA) to provide the highest quality chemicals possible, unparalleld pharmacist consulting support and top of the line continuing education in the field of compounding.
Q: What is compounding and how does it benefit me?
Pharmacy compounding is the art and science of preparing customized medications for patients. Its practice dates back to the origins of pharmacy; yet, compounding's presence in the pharmacy profession has changed over the years. In the 1930s and 1940s, approximately 60 percent of all medications were compounded. With the advent of drug manufacturing in the 1950s and ‘60s, compounding rapidly declined. The pharmacist's role as a preparer of medications quickly changed to that of a dispenser of manufactured dosage forms.
Within the last two decades, though, compounding has experienced a resurgence as modern technology and innovative techniques and research have allowed more pharmacists to customize medications to meet specific patient needs.
There are several reasons why pharmacists compound prescription medications. The most important one is what the medical community calls "patient non-compliance." Many patients are allergic to preservatives or dyes, or are sensitive to standard drug strengths. With a physician's consent, a compounding pharmacist can change the strength of a medication, alter its form to make it easier for the patient to ingest, or add flavor to make it more palatable. The pharmacist also can prepare the medication using several unique delivery systems, such as a sublingual troche or lozenge, a lollipop, or a transdermal gel or cream that can be absorbed through the skin. For those patients who are having a hard time swallowing a capsule, a compounding pharmacist can make a liquid suspension instead.
Q: Can my child (or my elderly parent) take compounded medications?
Yes. Children and the elderly are often the types of patients who benefit most from compounding. Often, parents have a tough time getting their children to take medicine because of the taste. A compounding pharmacist can work directly with the physician and the patient to select a flavoring agent, such as vanilla butternut or tutti frutti, which provides both an appropriate match for the medication's properties and the patient's taste preferences.
Compounding pharmacists also have helped patients who are experiencing chronic pain. For example, some arthritic patients cannot take certain medications due to gastrointestinal side effects. Working with their physician's prescription, a compounding pharmacist can provide them with a topical preparation with the anti-inflammatory or analgesic their doctor has prescribed for them. Compounded prescriptions often are used for pain management in hospice care.
Q: What kinds of prescriptions can be compounded?
Almost any kind. Compounded prescriptions are ideal for any patient requiring unique dosages and/or delivery devices, which can take the form of solutions, suppositories, sprays, oral rinses, lollipops and even as transdermal sticks. Compounding applications can include: Bio-identical Hormone Replacement Therapy, Veterinary, Hospice, Pediatric, Ophthalmic, Dental, Otic (for the ear), Dermatology, Medication Flavoring, Chronic Pain Management, Neuropathies, Sports Medicine, Infertility, Wound Therapy, Podiatry and Gastroenterology.
Q: Will my insurance cover compounded medications?
Because compounded medications are exempt by law from having the National Drug Code ID numbers that manufactured products carry, some insurance companies will not directly reimburse the compounding pharmacy. However, almost every insurance plan allows for the patient to be reimbursed by sending in claims forms. While you may be paying a pharmacy directly for a compounded prescription, most insurance plans should cover the final cost. At Hook's Apothecary, you will automatically receive a claim form for any compounded medication for humans. If you need a claim form for a veterinary compounded medication, please ask the staff and we will be more than happy to provide you with one.
Q: Is compounding expensive?
Compounding may or may not cost more than conventional medication. Its cost depends on the type of dosage form and equipment required, plus the time spent researching and preparing the medication. Fortunately, compounding pharmacists have access to pure-grade quality chemicals which dramatically lower overall costs and allow them to be very competitive with commercially manufactured products. Currently, the costs for compounded medications dispensed directly to patients or owners from Hook's Apothecary are averaging around $40 per month supply.
Q: Is compounding legal? Is it safe?
Compounding has been part of healthcare since the origins of pharmacy, and is widely used today in all areas of the industry, from hospitals to nuclear medicine. Over the last decade, compounding's resurgence has largely benefited from advances in technology, quality control and research methodology. The Food and Drug Administration has stated that compounded prescriptions are both ethical and legal as long as they are prescribed by a licensed practitioner for a specific patient and compounded by a licensed pharmacy. In addition, compounding is regulated by state boards of pharmacy.
PCCA's Quality Control department is exhaustively devoted to assuring the quality of the chemicals received, repackaged, and sold to our members. Steps include obtaining a Certificate of Analysis for all chemicals received, verifying the identity of every bulk chemical received both before repackaging and completing a second identity test after repackaging, conducting regular tests of all chemicals in inventory, and verifying all unique identifier numbers prior to shipping.
As a repackager of unformulated chemicals for pharmacy compounding, PCCA is registered and inspected by the FDA and DEA. The company is also licensed in the state of Texas and other states where licensure is required.
Please note that not all compounding pharmacies are the same. At Hook's Apothecary, we follow stringent quality control and quality assurance guidelines and routinely send finished compounded preperations for independent third party potency testing. We believe providing you with the highest quality compounded medication is our #1 priority.
Q: Does my doctor know about compounding?
Prescription compounding is a rapidly growing component of many physicians' practices. But in today's world of aggressive marketing by drug manufacturers, some may not realize the extent of compounding's resurgence in recent years. Ask your physician about compounding. Then get in touch with a compounding pharmacy - one that is committed to providing high-quality compounded medications in the dosage form and strength prescribed by the physician.
PCCA member pharmacists are encouraged to invite physicians to our seminars and symposiums, where they can learn about compounding while earning CME Continuing Education credit. Through the triad relationship of patient, physician and pharmacist, all three can work together to solve unique medical problems.
Q: What is PCCA's role in this?
PCCA now has become the nation's complete resource for compounding pharmacies. The company's members are more than 3,500 independent community pharmacists in the United States, Canada, Australia, Europe and New Zealand. PCCA provides high-quality fine chemicals and pharmacy equipment to members, plus a variety of ACPE-accredited training and continuing education classes for pharmacists and prescribing physicians. Click here for more information about PCCA.
Is custom compounding right for you? Ask your physician or one of our staff members today about the benefits of personalized prescription compounding.