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A few months ago,
Claudia McKeen BSc
Phm got a call for help
from a local doctor.
The doctor’s motherin-law was in a retirement home, but was
refusing to swallow her
medication. The doctor wondered whether McKeen,
president of Glebe Pharmasave Apothecary in Ottawa,
could use her special expertise in pharmaceutical compounding to find a solution to the problem.
McKeen got the details of the woman’s 10 prescriptions and spent the next day and a half compounding
them from pills and capsules into liquid so she could
take her medications in an easier to swallow format.
Pharmacy compounding is the art and science
of preparing customized medications for patients.
According to the Professional Compounding Centres
of America (PCCA), the practice of compounding goes
back to the origins of the pharmaceutical industry, but
has changed significantly over the last few decades.
In the 1930s and 1940s, about 60 percent of all
medications were compounded. With the advent
of drug manufacturing in the 1950s and ‘60s, compounding declined rapidly and the pharmacist’s role as
a preparer of medications changed to that of a dispenser of manufactured dosage forms.
COMPOUND
interest
Pharmacists are returning to
their roots in script preparation
Claudia McKeen BSc Phm,
president of Glebe Pharmasave
Apothecary in Ottawa, ON, says
her pharmacy now compounds
at least 30 scripts a day.
BY TALBOT BOGGS
PHOTOS BY EVA HADHAZY & JIM MILLER
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unique doses and/or delivery systems. They can
take forms such as suppositories, sprays, oral
rinses and can include bio-identical hormone
replacement therapy, veterinary, paediatric, ophthalmic, dental, otic, dermatologic, neuropathic,
sports medicine, infertility, wound therapy, podiatry and gastroenterology applications. Children
and the elderly generally are the most common
groups of patients who benefit from compounded
applications.
Compounding in
Canada is on the rise
The practice of compounding appears to be growing in Canada. IMS Health Canada reports there
were 8,223 pharmacies in Canada in 2008, which
were involved in compounding to some degree.
“We have no raw data, but from the independent surveys we’ve done with our pharmacies,
“problem-solvers and create solutions
We are no longer restricted by the inventory on the shelf. We become
to meet the unique needs
of our customers. It greatly enhances the level of patient care that we can provide.
Within the last 20 years, 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.
“It completely changes the mindset and culture of pharmacy and
the way pharmacists think,” says McKeen, who estimates her pharmacy
creates 10,000 compounds a year, about 30 every day. “We are no
longer restricted by the inventory on the shelf. We become problemsolvers and create solutions to meet the unique needs of our customers. It greatly enhances the level of patient care that we can provide.”
Virtually any pharmacy and pharmacist can compound. Simply
combining two types of creams together to create a new cream is
a form of compounding. However, as in McKeen’s example, compounding can become a lot more complicated, requiring a significant
investment of financial, human and physical resources.
Why compounding?
There are many reasons pharmacists compound prescription medications, but the most important is patient non-compliance with scripts.
Many patients are allergic to preservatives or dyes or are sensitive to
standard drug strengths. With a physician’s consent, a compounding
pharmacist can change the strength of a medication, alter its form to
make it easier to ingest, or add flavour to make it more palatable.
The pharmacist can also prepare medications using different
delivery systems, such as sublingual troche or lozenge, a lollipop, or a
trans-dermal gel or cream that can be absorbed through the skin.
Compounding pharmacists have been particularly successful helping patients with chronic pain who can’t take certain medications
because of gastrointestinal side effects by providing them with a special
preparation using the anti-inflammatory or analgesic prescribed by
their doctor.
Compounded prescriptions are often used for pain management in
hospice care, since they’re considered ideal for any patient requiring
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”
compounding represents on average one percent of
their total prescription volume,” says Ari Pailakian,
vice president and general manager of PCCA Canada. “Our feeling is that compounding is following
the growth of pharmacies in Canada, and the trend
is higher in urban areas and more prevalent in the
western provinces.”
McKeen, who is also vice president of the Association of Compounding Pharmacists of Canada,
estimates about 500 pharmacies across Canada
do compounding, but only about 10 or 20 are
serious, high-volume providers.
“There’s no question more pharmacists are
doing it,” says Anne Marie Picone-Ford BSc Phm,
co-owner of Ford’s Apothecary in Moncton. “It’s
a wonderful way to interact with the public and
physicians and to help patients in ways you otherwise couldn’t. It fills a niche where commercial
medications are not available.”
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. Compounding is regulated
by provincial boards of pharmacy along with
federal guidelines.
Most pharmacy education programs across the
country include some limited study on the subject,
but pharmacists who are serious about the practice
can find further in-depth study available through
the PCCA, which is responsible for monitoring
the identity and quality of the chemicals received
by its members and conducting regular tests of all
chemicals in inventory.
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Getting into compounding
Developing a compounding expertise requires
time, money and training, but the results can be
worth the effort.
Donald Pearson BSc Phm, LPh, FACA, coowner of Pearson and Alter Pharmacy in Montreal,
has been developing his compounding expertise
since 1998. He has a dedicated compounding team
of pharmacists and technicians who work from a
laboratory and compounding area of the pharmacy
to turn out about 300 compounds a week. He estimates it can cost a pharmacy up to $100,000 US
to develop a top-notch compounding business.
“It’s a whole new world (of pharmacy) that can
take years to establish,” says Pearson. “A lot of
pharmacists seem to be afraid of it because they
have to put out money for equipment and education, but more and more of them are getting to
know about it.”
prescription price depends largely on the time
spent preparing a mix and how that individual
pharmacist costs out a compound.” says McKeen.
“Most people are quite willing to pay the premium
for a product that meets their special needs.”
Because compounded medications are exempt
by law from having the national drug identification
number (DIN) code 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 claim
forms. While patients may pay the pharmacy
directly for a compounded prescription, most
insurance plans will cover the final cost.
McKeen believes compounding can help
independent pharmacies compete against the rising
juggernaut of the large chains. “The chains aren’t
doing it so much – they’re more into cosmetics
Anne Marie Picone-Ford BSc Phm,
co-owner of Ford’s Apothecary in Moncton,
NB, recommends that pharmacists who
want to build their compounding business
start slowly and methodically, focusing
initially on a particular area, such as
diabetes or bio-identical hormone
replacement therapy.
TAKEAWAYS
COMPOUNDING ...
• is a good way for independents to differentiate themselves from big chain pharmacies. It’s an opportunity to
return to a model of one-onone customer service and get
closer to your customers as
you meet their special needs.
• is an opportunity to forge
stronger relationships with
physicians. Many more physicians today are sending their
patients to pharmacists who
can provide specialized solutions, such as creating medications in “more palatable”
forms.
• that adds profit to your operation requires an investment
in developing the business,
educating yourself, and learning new skills. Start small
with a focus in an area such
as bio-identical hormone
replacement therapy or diabetes, then branch out.
• requires upgraded education.
The process of creating drugs
through compounding relies
on special technical skills and
equipment.
Brenda Yuzdepski BSP, owner of Medical Arts
Pharmacy in Saskatoon, adds that compounding
can be as complicated as you want to make it.
“Every pharmacy can compound, but only some
are advanced,” she says. “It can be a significant
investment, but it’s a good business decision.”
Picone-Ford suggests pharmacies start small
and build their compounding business slowly.
“Start with a specific focus, such as diabetes or bioidentical hormone replacement therapy,” she says.
“Start small and then move on.”
Compounding requires a great attention to
detail. “You have to be very conscientious and
careful,” says Picone-Ford. “You have to be very
accurate and constantly upgrade your procedures
and skills.”
Compounding prescriptions may or may
not cost more than conventional medication,
depending on the type of dosage form and
equipment required. “The average compound
and food,” McKeen says. “It’s a great way for the
independents to differentiate themselves. This is
big.” Compounding seems to meet a need in the
marketplace and is definitely back in fashion.
“It really helps people,” says Pearson. “It can
be a difficult process to manage because it is technical, requires special knowledge and equipment,
and it takes a while to become profitable because
you’re always investing in it and changing things,”
says Pearson. “But you know you’re really helping
people, which makes it very satisfying, not only
professionally but emotionally as well.” PB
Talbot Boggs is a communications professional who
has written extensively for newspapers, magazines
and organizations in the retail, convenience, pharmaceutical, healthcare and financial sectors.
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