Articles

Compounding Pharmacy in the News

In recent months compounding pharmacy has undergone increased scrutiny by the media, the government, and the public. Most people think of a pharmacy as their local Walgreens, CVS, or Eckerds where medications sit on a shelf in prepackaged bottles waiting to be counted and poured into individual prescription vials. In actuality, the advent of pharmacy started with simple active ingredients combined into pills, capsules, powder papers, suspensions, creams, and suppositories per a physician’s order for a specific patient. Pills were rolled by hand, carefully measured for weight. Powder papers had active ingredients measured and then separated into small sheets of wax paper. Patients would mix these with a drink or simply place the powder in their mouth and follow with a liquid to wash the medicine down. Suppositories were mixed with fatty substances and heated to a liquid, and then poured into a small suppository molds to solidify. Pharmacy compounding was considered an art and the privilege of the profession of pharmacy.

Starting in the early 1900’s large pharmaceutical companies began manufacturing volume quantities of a variety of drugs and dosage forms. Large volume production of prescription medications has slowly eroded the perceived need for compounding pharmacy. With the pharmacist shortage and the need to compete with large volume chains, many pharmacies have had to compromise the availability of compounding services for the convenience of commercially manufactured medications. With so many medications available from manufactured sources, why do we need compounding pharmacies?

Modern state-of-the-art compounding pharmacies are able to answer specific needs that bulk manufacturers can not accommodate. Compounding pharmacies can compound a prescription drug in any dose and form requested by a physician. This is important because manufactured medications are only available in certain strengths and dosage forms. Often children and the elderly require a medication in a dose form that is not commercially available. Per a physician’s order pharmacies can change the form of the prescription, for example from a capsule or tablet into a suspension, and change the flavor to make a medication more palatable.

The pharmaceutical industry has discontinued many drugs over the past several decades. Many were effective, but demand was low and now the only way they are available is through compounding. In other situations, drugs are not available on the market in the United States or are only available as orphan drugs. Compounding pharmacies can prepare these drugs per a physician’s prescription.

Compounding pharmacies can also help with drug shortages of commercially manufactured medications by compounding the drug from bulk supplies. A recent example is when Armour Thyroid 2 grain was unavailable and we were able to compound the 2 grain from the 3 grain size.

Compounding is also done in hospital and home health care settings, when physicians place orders for total parenteral nutrition (commonly referred to as TPNs). TPNs allow intravenous administration in patients who can not take medications or nutrition orally. Other needs driving compounding pharmacy include veterinary compounding, clinical study compounding, and nuclear compounding.

Given the importance and need for compounding pharmacy, many critics are still concerned with its regulation. Pharmacy is governed by the State Boards of Pharmacy. The Boards of Pharmacy enact laws establishing control and enforcement of the acts of pharmacy, including compounding. Bellevue Pharmacy Solutions complies and exceeds the compounding requirements set by the State Board of Pharmacy. Our pharmacy staff undergoes training on the art of compounding. We have processes in place to ensure that each prescription contains the appropriate ingredients and the correct amounts of those ingredients as prescribed on the physician’s order. Each prescription undergoes three checks by 3 different members of the pharmacy staff. Our sterile products are prepared in a class 100 clean room and are tested both internally and by an independent external lab as required. Bellevue Pharmacy Solutions is proud of the pharmacy tradition we maintain and believe that we meet an important need of the community.