Physicians Compounding Medications In-Office: Good Idea or Recipe for Disaster?
With the recent increase in demand for customized medical care and the significant rise in medication costs, many physicians are now urging the AMA to fight for the right to compound certain medications in their own office. Regardless of whether they eventually win that right, this movement brings up a needed conversation about how customized drug compounding can benefit our patients, and how the relationship between the pharmacist and physician is one of the key elements in conveying that benefit.
In 2012, over 700 patients reported to their physician for routine steroid injections to treat pain and other joint and spinal problems. What started as a simple and routine procedure quickly became a nightmare as hundreds of patients developed severe fungal infections, including meningitis. The outbreak was eventually linked to the specialty compounding pharmacy that had made the medication preparations.1 Strict regulations were put into place after that outbreak to ensure the safety of patients requiring these medications.
While this is a particularly egregious case and is not a common outcome, it does show the potential for serious complications and what needs to be done in order to protect patients and prevent this from occurring again. There are many steps that can be taken, both in the pharmacy and physician’s office, which can improve safety and good practice.
- A standardized training course and certification is needed, and should be required before physicians are allowed to undertake this role in their practice. The course would need to touch on basic infection control, compounding good practices and patient safety.
- In addition, physicians utilizing these techniques within their own practice should be subject to the same regulatory guidelines that compounding pharmacies are, including routine FDA inspections.
- Finally, having a knowledgeable and experienced pharmacist that a physician can call with questions and concerns is crucial. There are always clinical situations that come up that are atypical and may fall outside of the physician’s experience. Having a trustworthy person to call with these questions promotes both patient safety and good practice.
- Pharmacists aren’t off the hook either. Establishing and maintaining consistent standards and a quality training program in the pharmacy are crucial steps in improving patient safety.
It’s no secret that medication can be extremely expensive. This often leads to patients not taking their medication as instructed, or at all, in an effort to save money. For example, some reproductive endocrinologists prescribe a short-term course of Androgel prior to the woman starting her ovarian stimulation medication. While a single bottle can easily run over $550, the pharmacist or physician can compound individual doses based on the specific concentration and amount that the physician prescribed. This can easily save the patient several hundred dollars in medication costs.
In-office compounding of other drugs could save patients even more money. In an example taken from the June 2015 American Medical Association conference, physicians cite the cancer drug bevacizumab. If repackaged in-office, physicians can charge as little as $40 per dose, while patients are often spending more than $1,000 when purchasing the drug as a pre-packaged eye drop at the pharmacy counter.2
There seems to be an increasing trend towards patient-specific and customized medications, especially with the dramatic increase in food sensitivities and allergies. In-office compounding would allow physicians to customize medications based on a patient’s specific needs. Medications can be compounded to eliminate gluten, lactose, sugars, dyes, or other ingredients as needed.3
In addition to eliminating unwanted ingredients, compounding medications in office can also change the form in which the medication is administered — from intramuscular injection to subcutaneous injection, or pills to a liquid form — or add flavorings for pediatric or sensitive patients.
What Does Compounding Medications In-office Mean for You as a Pharmacist?
This isn’t a change that will come overnight, but it does present an opportunity for pharmacists to become more involved in their local medical community. Further, these benefits aren’t exclusive to in-office, physician compounded medications. Reach out to local dermatologists, oncologists, reproductive endocrinologists and other specialists to learn about their patient population and needs. By offering to prepare compounded meds that are specially tailored to their patients, you can create long-lasting professional relationships that will help you build your practice and business.
Many physicians would welcome additional information for their patients and staff, giving pharmacists the opportunity to prepare patient education materials and staff learning in-services. Physicians might also increase their use of compounded medications if they were aware that the pharmacy used pre-packaged and standardized products to prepare their patient’s medications. While this does take time, the effort can go a long way towards solidifying those relationships.
In either situation, a solid relationship between pharmacist and physician benefits everyone involved: patients receive excellent, safe, and affordable care; pharmacists can grow their practice substantially; and physicians have a reliable source of information that they can tap into.
Pharmaceutica North America would like to be your resource for in-office compounding ingredients. By offering bulk materials, pre-measured kits, and responsive customer service, we make it easier than ever for physicians to add on-site prescriptions to their practices. Please contact us today to learn how we can help take your practice to the next level.
- “Feds File Murder Charges in Fungal Meningitis Outbreak,” last modified December 17, 2014, http://www.nbcnews.com/health/health-news/feds-file-murder-charges-fungal-meningitis-outbreak-n270106 ↩
- “Coverage from 2015 AMA Conference,” last modified June 8, 2015, http://www.hcplive.com/conference-coverage/ama-2015/docs-fight-for-right-to-compound-drugs ↩
- “Benefits of Compounding,” http://www.pccarx.com/prescribers/benefits-of-compounding ↩