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Frequently Asked Questions
The following are questions that are most frequently asked either by the Prescriber or the Patient. Table of Contents
What is Compounding?This age-old art and science dates back as far as the ancient Egyptians and is even mentioned in the Bible. Compounding’s role within the pharmacy profession has changed over the years. In the 1930's and 40's, approximately 60 percent of all medications were compounded to meet a Prescriber's unique prescriptions. In the 1950's and 60's, due to mass production of medications by large drug companies, compounding became a dying art. As time passed, the pharmacist’s role as a preparer of medications quickly changed to that of a dispenser of manufactured dosage forms. During the last two decades, compounding has experienced a rebirth, allowing the pharmacist, with the use of modern technology, innovative techniques, and research, to customize medications to meet specific patient needs. It is estimated that today approximately one percent of all prescriptions are compounded daily by pharmacists working closely with physicians and their patients. The modern compounding facility looks more like a laboratory than a conventional pharmacy. The compounding process requires extra time, involving research, measuring, and mixing pure ingredient chemicals, packaging, and labeling, resulting in a customized medication made by the pharmacist according to a Prescriber’s specifications to meet the unique needs of an individual patient. Today physicians and pharmacists, keeping up with the most current research, can work together to find solutions for patients with special needs. A compounding pharmacist can be an excellent resource in patient care to improve patient compliance and outcomes. View Power Point - Overview of CompoundingWhy would I want or need to have a prescription compounded?If you need a specific medication, medication strength, or dosage form that is not commercially available, then your medication must be compounded. One of the most important reasons for compounding is “Patient Non-compliance.” The patient may be allergic to preservatives or dyes, or sensitive to standard drug strengths. Following a prescriber's specifications, a compounding pharmacist can change the strength of a medication, alter its form to make it easier to ingest, or add flavor to make it more palatable. The pharmacist also can prepare medications using unique delivery mechanisms, such as sublingual troches or lozenges, lollipops, suppositories, or transdermal gels. If there is difficulty in swallowing a capsule, because of age or disability, a compounding pharmacist can put the medication in a suspension. Why can’t a regular pharmacy compound my prescription?A compounding only pharmacy uses state-of-the-art equipment, mixing pure ingredient chemicals and advanced techniques to compound and ensure the quality of its products. Other pharmacies do not have the time, equipment, chemicals, or education to “custom-make” your medications What about cost?A compounded medication may or may not be higher than a conventional medication, depending on the type of dosage form required. Equipment needed, research, and actual compound time all add to the cost of a compound. Fortunately, compounding pharmacists have access to pure grade pharmaceutical quality chemicals, which can lower their overall costs and allow them to be very comparable to manufactured products in costs. Is it possible to get combination medication formulations?Yes, there are times when more than one active ingredient is needed at the same time in a medication. Only compounding can solve this problem. Especially for a pain clinic or hospice patient, the need for multiple dosages is important, and routes of administration are crucial to getting exactly what is needed without having to take several tablets or capsules around the clock. What about dosage forms?There are multiple dosing forms and devices available through the compounding route. See Compounding Dosage Forms, but in reality, the list is endless. From gels to topicals, orals to rectals, creams to lollipops, the sky is the limit. What would best fit your patient's individual needs is the question. What types of things do you compound?
Will compounding enhance your patient’s compliance and assure you, the Prescriber, that you’re getting the results you need for effective treatment?Yes, for example, the patient who complains about the side effects from non-steroidal arthritis drugs taken orally on a continuous basis has the option of applying a topical compound dosage form of the medication and alleviating the side effects. Or the patient on high doses of analgesic combined with acetaminophen and is at risk of acetaminophen toxicity has the option to use a compounded version with less acetaminophen, lessening the toxicity risk. So compounding can alleviate many problems associated with patient compliance. What are the legal aspects of compounding?As a prescriber in the US, a physician can readily order a compounded medication for anything when he/she feels it is the best route to take to medicate a patient. The FDA gives great deference to doctors to use their judgment about dosage forms, routes of administration, and medications needed to treat their patients. Compounding has been part of the health care system for over 400 years and is still used in all areas of pharmaceuticals today from hospitals to nuclear medicine. We will be glad to furnish you with updated information on new compounding laws as they pertain to pharmacists and physicians. A pharmacist’s or physician’s liability when using a compounded medication is no greater than when using a commercially available product. Both must still follow accepted guidelines of professional practice recognized by their respective professions. State boards of pharmacy test, license, and regulate the traditional practice of pharmacy including compounding. Recently, the National Association of Boards of Pharmacy developed “Good Compounding Practices Applicable to State-Licensed Pharmacies” and the United States Pharmacopoeia Convention, Inc. Drafted “Pharmacy Compounding Practices”. In 1997, legislation was passed as part of the Food and Drug Modernization Act (FDAMA) that sets forth the legal parameters for compounding medications. These documents all recognize the importance of compounding to quality medical care in the United States, and establish standards for the entire profession of pharmacy. Why don’t you accept insurance?What about insurance reimbursement to your patients: Since compounded medications are exempt by law from having a NDC number (national drug code ID number reserved for manufactured products) many insurance companies will not reimburse the compounding pharmacy directly. However, most insurance plans allow for the patient to be reimbursed directly by sending in claim forms that we can provide and help them properly fill them out to expedite reimbursement. So the patient will be paying the pharmacy directly in most cases. Again, patient education is the key, and we will help in this process. What about Prescriber and Patient Education?Many prescribers are unaware that compounding can, in fact, be done, or even is still done in today’s market of high-tech multi-level marketing of manufactured products. As your compounding pharmacy, we are committed to providing you with the latest literature that will enable you to feel confident about the process of compounding. We assure you of our willingness to work with you in the research and development of new compounds, devices, dosage forms, and their interactions. We will fully discuss with the patient their specific needs and problems and through communication with you, the prescriber, develop the proper medication and dosage form for your patient. See Seminars/In-service for the Prescriber and Seminars for the Patient. |