Custom Compounding Services

Introduction

Commonly, most people view a mortar and pestle as symbol of pharmacy. However, some people still may remember a time when the pharmacist would prepare medication in a mortar and pestle using tinctures and syrups and special formulas.

Extemporaneous compounding is as old as the pharmacy profession itself and is, in reality, the traditional way that medicines have been prepared for patients. For centuries pharmacists made their own tablets, tinctures, and tonics by hand, grinding, weighing, and compounding them into various formulations. Each patient's unique needs were taken into consideration as the pharmacist prepared a treatment that met the exact specifications of the prescribing physician.

From a historical perspective, compounding was and is essentially the "art of pharmacy." This meant traditional pharmacists or druggists had distinct knowledge and skills to prepare or compound a medication in whatever form necessary to treat a particular patient's exact need. Therefore, it is ironic that the last 50 years have seen the mass production of medications by big drug companies come to be considered the "traditional" method of medication supply. In fact, the advent of mass manufacturing has caused a shift in the practice of medicine away from the individual patient. Unfortunately, this system can treat most people most of the time, but not all of the people all of the time.

At Cox Pharmacy we understand that no two patients are the same, and it is impossible for manufactured medicines to meet all patient needs. Furthermore, in every medical practice there are a few patients who have not responded to traditional treatment or who have a unique need or medical circumstance. In the past, physicians didn't face these challenges because they had more options and therefore more flexibility to have a pharmacists prepare a customized medication for a specific patient.

At Cox Pharmacy, we believe compounding is essentially about providing options and thus opportunities for various health care providers and their patients to solve therapeutic problems where no solution may otherwise be found. We believe it is our role to provide you with these options.

Although we still employ many time-honored techniques, modern compounding is very different from its historical predecessor. Cox Pharmacy now features an on-site state-of-the-art compounding laboratory. As members of the Professional Compounding Centers of America (PCCA), we are committed to the art and skill of prescription compounding and have made a significant investment in obtaining pure drugs and chemicals along with highly specialized equipment in order to make these medications. Through PCCA, our pharmacists and staff also acquire specialized education and training for compounding, which is now considered unique to the profession of pharmacy.

If you are one who still believes a mortar and pestle is just a symbol of pharmacy, we invite you to stop by and visit our modern compounding facility. You'll find advances in chemistry and technology that allow medications to be compounding in forms that aren't even available commercially.

If commercially available medications are not meeting your needs or you feel that you or someone you know could benefit from our compounding services and would like more information, we encourage you to discuss with our pharmacists the personalized compounded solutions that may be available.

Also, for additional information about compounding, please browse through the additional information included below or feel free to give our compounding pharmacists a call at (918) 456-2233 or toll free at (866) 269-5556.

Frequently Asked Questions About Compounding

What is Compounding?

Definition:

Compounding is the preparation, mixing, assembling, packaging, or labeling of a drug or device as the result of a practitioner's prescription drug order or initiative based on the practitioner, patient, pharmacist relationship in the course of professional practice, or for the purpose of or as an incident to, research, teaching, or chemical analysis and not for sale or dispensing. Compounding also includes the preparation of drugs or devices in anticipation of prescription drug orders based on routine, regularly observed prescribing patterns. A customized medication prepared by a pharmacist according to a doctor's specifications to meet an individual patient need. Pharmacists make medications from "scratch" using raw chemicals, powders and devices.

History:

Compounding is inherent in pharmacy practice and is the birthright of the profession. The practice of preparing medications dates back to biblical times. Some of the earliest references to pharmacy are related to compounding. Exodus 30:25, for example, advises, "And thou shalt make it an oil of holy ointment, an ointment compound after the art of the apothecary: it shall be a holy anointing oil."

In those days priests or medicine men ministered to the sick with topical potions and syrups, as they carried out religious rites and ceremonies. In fact, many peoples of the world still place significant importance upon the use of drugs or medicine in association with their religion or faith. The first recorded compounding evidence occurred in the early 9th century around Baghdad. Gradually this science spread to Europe and eventually became alchemy and then chemistry. As the profession evolved doctors began to abandon beliefs that were not demonstrable in the physical world. Although many doctors were preparing their patients' medicines during this period, they also began prescribing medicines for their patients which could in turn be made by a pharmacist. Then pharmacists not only began to compound prescriptions, but manufactured medicaments in bulk lots for general sale. It was not until the 19th century that there was a distinct difference between the pharmacist as a compounder of medications and the physician as the therapist.

In the 1930s and 1940s, approximately 60 percent of all medications were compounded. During the 1950s and 60s, with the advent of manufacturing, compounding declined. The pharmacists's role as a preparer of medications quickly changed to that of a dispenser of manufactured dosage forms. Within the last two decades compounding has experienced a resurgence as modern technology, innovative techniques and research have allowed more pharmacists to customize medications that meet specific patient needs. In the 1990's, even with the growth of compounding only a few pharmacies have qualified compounding pharmacists and can offer these specialized services. Today, an estimated one percent of all prescriptions are compounded daily by pharmacists working closely with physicians and their patients.

What is the difference between manufactured and compounded medications?

Manufactured Medications
• No specific patient in mind when drug is produced
• Has prescribers matching patients to the product available
• Economic considerations limit choices in drug dosages and dosage forms

Compounded Medications
• Making the formula match the patient's needs
• Flexibility to prepare a drug in the most effective dosage form which could be applied directly at the affected area.
• Many compounded medications are actually more affordable than the commercially available therapeutic equivalent.

The Triad Relationship

The single most distinguishing feature of compounding is the specific relationship that is required between the Patient, Physician and the Pharmacist. Compounding is achieved through this essential triad relationship. The physician first prescribes the medication, then the pharmacist takes the necessary ingredients, compounds them, and dispenses the medicine to the patient after a thorough consultation. This enables patients to receive the type of personalized care they deserve and allows independent community pharmacists the opportunity to provide superior, patient-oriented services.

What are the benefits of Compounding?

There are several reasons why pharmacists compound prescription medications; yet, the most important ones are patient compliance issues. Many patients are allergic to preservatives or dyes, or are sensitive to standard drug strengths. With a physician's prescription, a compounding pharmacist can change the strength of a medication, alter its form to make it easier for the patient to ingest, and add flavor to it 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. For those patients who have difficulty swallowing a capsule, a compounding pharmacist can make a suspension instead.

Often parents have difficulty getting their children to take their 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 for the medication's properties and the patient's taste preferences.

Compounding pharmacists have also helped patients who are experiencing chronic pain. For example, arthritic patients who cannot take certain medications due to gastrointestinal side effects. Working with their physician, a compounding pharmacist can provide these patients with a topical preparation with the anti-inflammatory or analgesic their doctor prescribed for them.

Compounding pharmacists focus on meeting special needs. This may involve compounding an eye drop in a sterile compounding lab, an injection for impotency, preparing medications for veterinarians in a variety of dosage forms and flavors, providing natural alternatives in hormone replacement therapy, or assisting physicians in treating hospice patients.

The ultimate goal in preparing any of these customized medications is to help the physician and patient achieve a more positive therapeutic outcome.

Why don't all Pharmacies Compound?

All registered pharmacists are actually permitted by law to compound as part of the practice of pharmacy. However, pharmaceutical compounding requires a higher level of dedication to pharmacy than just "mixing" various chemicals together. It requires that all compounding pharmacists be specially trained and knowledgeable about the strengths and challenges of compounding. For example, some pharmacy owners are unable to allow for the additional time required to prepare a customized medication. It is also necessary to make a substantial financial commitment to purchase specialized equipment and chemicals that are not available in most pharmacies. Finally it is very important that a compounding pharmacy be comprised of pharmacists and pharmacist technicians who have had extensive training in modern compounding techniques and attend continuing education seminars regularly.

What gives a pharmacist the right to prepare a compounded medication?

No other health care professional has studied chemical compatibilities and can prepare dosage forms. Even when modern scientific technologies have produced new chemical entities, the ability of the pharmacist to combine one or more chemicals into a new preparation or process the existing dosage form into one that is better suited to the patient's needs, has remained the domain of the pharmacist. Compounding of medications by pharmacists is a long-standing and traditional part of pharmacy. The right - if not the obligation - to compound exists under the pharmacy laws of each of the fifty states and is pervasively regulated by the fifty states. States require that pharmacy schools must, as part of their core curriculum, instruct students on the basics of compounding.

Is compounding legal?

Yes. Compounding is legal throughout the United States, and the importance of compounding has been recognized by Congress. On November 9, 1997, Congress passed the Food and Drug Administration Act of 1997 ("Modernization Act"), amending the Federal Food, Drug, and Cosmetic Act (FDC Act). The Modernization Act includes new section 503A "Pharmacy Compounding," which recognizes that pharmacy compounding is legal in the United States. In its report on the issue, Congress made it clear that patients must be permitted to have continued access to the important health care services provided by compounding pharmacies. The sponsor of the law, Senator Tim Hutchinson of Arkansas, stated that the purpose of Pharmacy Compounding law is to "ensure that pharmacists and doctors across the country will be able to continue to provide individualized care and treatment of their patients". Congress passed the Pharmacy Compounding law at the direction of pharmacists who wanted clear Congressional recognition that compounding was an important component of pharmacy practice.

Will my insurance cover compounded medications?

We won't know until we try to submit an electronic claim for you. Although most plans do extend coverage for compounded prescriptions to their customers, there are variables that can limit the extent of this coverage. Compounded medications claims may include more than one active ingredient, or may include a non-formulary ingredient, or simply may not be recognized by the computer system your insurance company utilized to process the prescription. If their system does not recognize your claim, we can provide you with a claim form and can assist you with its completion. In that way, you may still submit a claim for later reimbursement

Is compounding expensive?

Compounding may or may not cost more than a conventional medication. Its cost depends upon 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.

Does my doctor know about compounding?

It is unfortunate that many patients, and even doctors, are unaware that specialty compounding pharmacies are now more active than ever in advancing the art and science of compounding.

In today's world of aggressive marketing by big 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 that is committed to providing high quality compounded medications in the dosage form and strength prescribed by the physician. Through the triad relationship of patient, physician and pharmacist, all three can work together to solve unique medical problems.