Opportunities in compounding for community pharmacists

There are increasing pressures on the dispensing fee model, among them:

• Extended days’ supply
• Generic cutbacks
• Rising healthcare costs: biologics

Also adding pressure in the pharmacy are drug shortages, discontinued medications and patients' continuing requirement for individualized medications that take into account allergens, dosage forms and flavouring. Maybe it's time to consider adding compounding to your pharmacy.          

5 Top reasons compounded prescriptions are written:

Ingredient alteration - 35%

Compounding for drug shortages - 20%

Alternate dosage forms - 20%

Veterinary compounding - 10%

Strength variations - 15%

Compounding can lead to strong patient retention     

• Specialty services
• Close relationships
  • Consultations, offers for novel services based on needs
• Individualized needs met
  • Allergen-free, sugar-free, aspartame-free, flavouring, tailored therapies/dosing, combination products
• Superior products: mouthwashes, synergistic API action, specialty bases
• One-stop pharmacy

Staff satisfaction

But it's not just patients who can benefit from access to compounded medications. Pharmacy staff may also appreciate the opportunities in adding compounding to their expertise.

Compounders are problem solvers. Here are a few of the many reasons compounding can expand pharmacy staff's satisfaction level:

• Challenges talented staff
  • Pharmacists: development of patient-specific formulations, continuing education opportunities, clinical services, specialties (cosmetic, pain, BHRT)
  • Technicians/assistants: more than just ‘counting pills’, increased responsibility, satisfaction of creating something that helps a patient
• Compound design and development
• Physician/patient partnerships
  • Compounding pharmacies become ‘problem-solving centres’ for physicians
• Patient relationships
  • Being the solution to previously unanswered problems, frequent dispensing (14-day suspensions), pediatric care

Paired clinical services and marketing opportunities with other healthcare professionals

Compounding opens new doors for cross-services with other healthcare and wellness professionals:

• Physicians: pain, derm, BHRT, pediatrics, palliative
• Dentists: mucosistis, coagulation rinses, dry mouth, pain, gag reflex
• Home healthcare nurses: wound care, pain, palliative
• Physical therapists: pain, athletic creams
• Podiatrists: wound care, pain
• Athletic trainers: pain, athletic cream, BHRT
• Cosmeticians: anti-aging, scar, hair loss, derm, BHRT
• Health spas: anti-aging, scar, hair loss, derm, BHRT
• Weight loss clinics: anti-aging, BHRT

Strategies for effective and sustainable compounding

• Pharmacy-specific formulations
  • Recommended and marketed to physicians
• Bulk compounding = efficiencies and savings
  • Decreased ingredient cost
  • Decreased time to compound
  • Limitations: dating
    • Choose creams and capsules (extended dating)
• Partner with other pharmacies in your area
• Central fill

Billing considerations

Patients need to understand that not all compounds are covered. Some considerations:

• Limited to back orders, appropriate suspensions, evidenced compounds, preservative free eye drops
• Does not include: pain compounds, hormones, cosmetic use
• Many insurers do not pay for quality ingredients, time to prepare, dispensing devices (tubes, pumps, suppository molds)
• Fee structure differs across the country in terms of what's covered.

For these reasons, compounds may be out of pocket paid by the patient. You need to be able to price appropriately for your time and resources. You also need to determine correct pricing for your patients based on the quality of ingredients.

• Better quality = higher price (enhanced efficacy or elegance for those patients who can afford it and basic ingredients to help affordability for patients with financial restrictions)

How to get started in compounding

Contact compounding suppliers or associations for equipment, startup advice, partnerships and memberships. Review Canada's plus your province or territory’s guiding documents and regulations on compounding.

References

• The Association of Compounding Pharmacists of Canada (ACPC) 
• United States Pharmacopeia
• Model Standards for Pharmacy Compounding of Non-Sterile Preparations.
• NAPRA Guidelines to Pharmacy Compounding