What To Do When Your Doctor Prescribes A Custom-Compounded Medication
When I graduated from college, I went to a department store and bought my first off-the-rack suit for my upcoming job interviews. It was a nice suit, but it made my lean frame look like a box. Despite that suit, I landed my first job, for which I needed several more suits. But this time after buying them, I took them to a skilled tailor, who for a very small price nipped and tucked the fabric in a few strategic places. The result was a collection of custom-tailored suits that fit me perfectly. I looked and felt like a million bucks.
Compounding: Like a Custom Tailor
When your physician prescribes a custom-compounded thyroid medication for your condition, he is she is essentially sending you to a custom tailor of medicine, who will prepare the exact dosage and form that is right for you. Compounded medications are made just for you, allowing your doctor to specify the appropriate active ingredients, dosage form, strength, size — and even the flavor —that is best for you. Your prescriber will give you a prescription just like any other prescription, and let you know that you need to find a compounding pharmacy to fill it for you.
When it comes to filling your prescription, you have options. You can take it to a local compounding pharmacy. By law, you can’t e-mail your prescription to a pharmacy, but you can mail it. This allows you to use any compounding pharmacy you choose, perhaps one that will deliver your medication to your home. Of course, your prescriber can fax or call your prescription to any compounding pharmacy.
A Very Brief History of Compounding
Custom compounding of medicine has been practiced by pharmacists since the earliest days of pharmacy. In fact, there was a time when all medicines were custom made. But since the advent of high-volume manufacturing of pharmaceuticals, most people today are familiar only with “off-the-rack” medicines.
In the 1950s, pharmaceutical companies appeared and changed the way medications were made. They were able to manufacture medicine on a large scale to serve many patients. Around the same time, insurance companies started affecting the way medicine was prescribed by doctors and filled by pharmacists, changing pharmacists’ role to dispensing more so than compounding. The result was a decline in the need for or reimbursement of compounding, and the large chain pharmacies of today became the new norm. As long as people continue to have unique needs for custom medications, or needed medications become commercially unavailable, there always will be a need for compounding. That is why doctors still write prescriptions for compounds today.
The Basics About Compounding
You probably have questions about compounding. How do I find a compounding pharmacy? What will it cost? Is it safe? What goes into it?
Millions of Americans have unique health care needs that off-the-shelf prescription medications cannot meet. Because every patient is different and has different needs, customized, compounded medications are a vital part of quality medical care. For many people, personalized medications — mixed safely by trained, licensed pharmacists — are the only way to better health.
Pharmacists are the only healthcare professionals who have studied chemical compatibilities and can prepare alternate dosage forms. In fact, each state requires that pharmacy schools must, as part of their core curricula, instruct students about compounding pharmaceutical ingredients. Compounding pharmacies are licensed and regulated in the 50 states and the District of Columbia, by their respective state boards of pharmacy.
Physicians prescribe compounded medications for a variety of reasons:
- When needed medications are discontinued by or generally unavailable from pharmaceutical companies, often because the medications are no longer profitable to manufacture;
- When the patient is allergic to certain preservatives, dyes or binders in available off-the-shelf medications;
- When treatment requires tailored dosage-strengths for patients with unique needs (for example, an infant);
- When a pharmacist can combine several medications the patient is taking to increase compliance;
- When the patient cannot ingest the medication in its commercially available form and a pharmacist can prepare the medication in cream, liquid or other form that the patient can easily take; and
- When medications require flavor additives to make them more palatable for some patients, most often children.
Compounding pharmacies come in all sizes and configurations and are located throughout the United States. Some fill a few prescriptions for compounded medicines every day, some fill thousands. Some specialize in a few compounds, such as bio-identical hormone replacement therapies, or medicines used by urologists, ophthalmologists or veterinarians, while others provide a range of compounded medicines for human and animal use. To find a compounding pharmacist, near you, visit the websites of the International Academy of Compounding Pharmacists or the Professional Compounding Centers of America and use their pharmacist-locator tools. You also may want to use Google or Bing to search for “compounding pharmacy.” Since results from these search engines are tuned to your location, you’ll see local pharmacies first among your search results.
Choosing the Compounding Pharmacy That’s Right for You
Start by asking your doctor for a recommendation of a compounding pharmacy. If he or she has prescribed a compounded medication for you, chances are that he or she will know where you can have the prescription filled in a safe, professional, affordable and convenient way. If your doctor recommends several pharmacies or you decide to evaluate your choices, here are some things to look for:
- Experience: Some pharmacies compound medicines as a sideline and some do nothing but compounding. Be sure that the pharmacy has specific experience with the medicine you need. As in any area of healthcare, you always want to deal with the professional who has the most experience in a specific procedure;
- Affiliations: Check for professional affiliations such as membership in the International Academy of Compounding Pharmacists (IACP), the American College of Apothecaries (ACOP) and Professional Compounding Centers of America (PCCA), and independent certifications such as PharmacyChecker;
- Quality: Will your medicine be prepared on a counter next to the greeting cards or in a climate-controlled laboratory? Is every step of the compounding process from prescribing to compounding and labeling through dispensing reviewed and verified by a licensed pharmacist? Are the ingredients purchased from FDA-registered suppliers?
- Convenience: Will you have to drive across the city or the state to pick up your prescriptions or can you have it delivered to your door? Can you refill online and pay with a credit card? Can you refill 24/7? Can you track the progress of your order and its delivery? Will the pharmacy assist you with insurance-claims processing? Does the pharmacy have professionally trained staff who can answer your questions? Does it offer other resources that can help you manage your condition such as user groups, forums and online libraries?
You should be confident in the medication you receive from a compounding pharmacy. Some compounded medications — but not those commonly prescribed to treat thyroid conditions — must be prepared under sterile conditions, for example, and require complex facilities and equipment to do so safely. So you should do what you can to ensure that the compounding pharmacy you select is doing everything it can to ensure accuracy and quality for the drugs made especially for you. We have a checklist on our website of more than 20 factors you may want to consider.
About Compounded Thyroid
There are a few types of thyroid medications available to patients. Armour Thyroid is a naturally occurring thyroid and has the ratio of T3 to T4 (four-to-one). Wedgewood Pharmacy compounds thyroid using desiccated thyroid USP, which, like Armour, comes from a natural source. There are also synthesized versions that combine T3 and T4 into this same ratio.
The difference in pricing between manufactured thyroid and compounded thyroid varies greatly. Some people may pay more for a compound than a manufactured medication, while others will end up paying less. Three factors can affect price. Different pharmacies and manufacturers have different equipment; compounding pharmacies tend not to have the economies of scale that a manufacturer may have; and most compounds are made by the hand of a pharmacist as opposed to a machine, all of which can affect the final price. Check with your compounding pharmacy to see how its pricing compares to what you may have paid for a similar manufactured drug.
Thyroid compounds prepared by different compounding pharmacies may use different fillers. Therein lies the art behind the science of compounding. The industry standard is to use inert ingredients that have no therapeutic effect. You may discuss alternate fillers with your doctor and pharmacist if you have certain allergies. Because there have been no studies conducted on fillers as they relate to the bioavailability of thyroid, the standard fillers found in most medications typically are used in compounding thyroid medications.
There are no formal studies available for thyroid, or for alternate dosage forms such as thyroid in a transdermal dosage form. That’s because thyroid has been prescribed by doctors for many decades, so when the FDA was created in the 1930s, it was grandfathered without the requirement to conduct new-drug studies. The cost to complete such studies is significant, and apart from a few university studies, no companies have stepped up to formally look at thyroid for its efficacy.
If the medicines you need are prêt-à-porter (ready to wear) you may not have to give much thought to where you fill your prescriptions. But if custom-tailoring is the right choice for you, you’ll want to assure yourself that your tailor has plenty of experience and the right tools for the perfect fit.
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