What is compounding?

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 throughout 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, however, 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. Today, an estimated one percent of all prescriptions are compounded daily by pharmacists working closely with physicians and their patients.

How does compounding benefit me?

There are several reasons why pharmacists compound prescription medications. The most important of these is what the medical community calls “patient non-compliance.” Many patients are allergic to preservatives or dyes or are sensitive to standard drug strengths. Fortunately, with a physician’s consent, a compounding pharmacist can change the strength of the medication, alter its form to make it easier for the patient to ingest, or add flavor to it to make it more palatable. The pharmacist can also prepare the medication using several unique delivery systems such as a sublingual troche or lozenge, a lollipop, or a transdermal gel. For those patients who are having a difficult time swallowing a capsule, a compounding pharmacist can make a suspension instead.

Can my child (or my elderly parent) take compound medication?

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 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 that provides both an appropriate match of 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, 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.

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, Dermatology, Medication Flavoring, Chronic Pain Management, Neuropathies, Sports Medicine, Infertility, Wound Therapy, Podiatry, and Gastroenterology.

Will my insurance cover compound 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 by paying a pharmacy directly for a compounded prescription, most insurance plans should cover the final cost.

Does my doctor know about compounding?

Compounding has been part of healthcare since the origins of pharmacy and is used widely 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. Also, compounding is regulated by state boards of pharmacy.

What does transdermal pain management mean?

Transdermal pain management means that pain relief medication is delivered topically, directly to the site of the pain, rather than ingested orally. Transdermal pain management helps pain sufferers to relieve their symptoms without the stomach irritation and other unwanted side effects that orally ingested medications can cause.

Bio-Identical Hormones
What are bio-identical hormones?

Bio-identical hormone is a medical term for hormones that are considered to be "natural" as opposed to synthetic hormones. Bio-identical hormones derive from plant sources such as soybeans or yams. The phytoestrogens found in these plant sources are converted by enzymatic processes in a laboratory to the hormones identical to the ones produced by the body - hence the term "bio (body) identical hormones." Our bodies do not contain the enzymes required to convert the phytoestrogens to bio-identical hormones; so if one ingested the plant, there would be no effect because the body could not convert it to hormones.That is where bio-identical hormone replacement comes in.

What is bio-identical hormone replacement?

Bio-identical hormone replacement is available in a variety of dosage forms including capsules, topical creams, vaginal creams, suppositories, and injections.

How are bio-identical hormones used?

The Bio-identical sex hormones such as progesterone, testosterone, estrone, estradiol, and estriol are used in pre-menstrual syndrome, peri-menopause, and post-menopause in women to lessen the effects of the declines that these hormones experience in the mature years of life. They are prescribed as replacement quantities, usually based on levels acquired through saliva or blood testing. Testosterone is often used for the purpose of enhancing libido in women and increasing bone growth. Bio-identical hormones are also used in men for the same purposes, as well as others symptoms associated with andropause, which is like menopause in males.

What does compounding bioidentical hormones mean?

Pharmacy compounding is the art and science of preparing customized medications for individual patient needs. The science of compounding bio-identical hormones addresses many problems faced by healthcare providers and assists in meeting specific patient needs. Many patients are allergic to preservatives or dyes in standard drugs or are lactose intolerant, and a compounding pharmacist can compound bio-identical hormones and other medications that are free of preservatives, dyes, and lactose. Other patients may have a difficult time taking medications in their available form. Another benefit of compounding bio-identical hormones and other medications is the ability to change the strength, dosage form, or flavor of the commercially available drug, making it easier to take. Whether a different strength, altered dosage form, or more palatable flavor is needed, compounding bio-identical hormones can be the solution to many patients' needs.

What is the benefit of saliva testing over blood testing to test my hormone levels?

Salivary hormone testing is considered to be a highly reliable testing procedure. First, a major point to consider is that saliva testing measures only the level of active--or free hormones--while blood tests measure bound--or inactive--hormones, as well. Another benefit of saliva testing over blood testing is the convenience of testing at home. You can pick up a test kit at our pharmacy and perform the simple test in the comfort of your home. You then mail in the test tubes to the lab using the return mailer that is supplied with the trial kit. In most cases, your insurance will cover the test if your doctor writes an order for the test.

What does natural hormone replacement therapy mean?

Natural hormones for therapy are available in a variety of dosage forms including capsules, topical or vaginal creams, gels, troches, or suppositories. Those forms that are topically applied do not undergo a process called first pass metabolism by the liver like the forms that are swallowed. Lozenges that are placed in the cheek or under the tongue also bypass this process; however, troches and lozenges can be flavored to individual preferences to make natural bio-identical hormones therapy more pleasant to take.

Still have questions? Schedule a complimentary Ask Everwell consultation with the team of experts at Everwell Specialty Pharmacy to learn more!