By Joe Goldeen
Posted Jul 2, 2006
Pharmacies dispense pills, right?
The fact is, a lot of people can’t swallow pills or capsules, or they need a dosage in a strength not available from the drug maker, or they simply don’t respond well to traditional prescription medications. They may have an allergic reaction to a preservative or a dye, or their stomachs are sensitive to standard dosages.
And have you ever tried to give a pill to a cat?
The growing trend of compounding pharmacies is in response to the need and the technology available to allow pharmacists trained in compounding to prepare customized prescription medications in numerous forms such as liquids, ointments and creams, lozenges and lollipops - even rectal rockets, an aptly named description for a type of suppository.
Longtime Stockton pharmacist Charlie Green, owner of two Green Brothers Pharmacies, has been compounding for years. But this week, he and one of his managers, pharmacist Marie Cottman, opened a store in an upscale shopping center that is the first in the county to specialize exclusively in preparing compound prescriptions. They also serve the veterinary market.
“We simply outgrew our space at Green Brothers,” Green said.
Pacific Compounding Pharmacy and Consultations, 505 North Lincoln Center, occupies a 650-square-foot unit next to Village Cleaners in one of north Stockton’s busiest retail centers.
“This is where our clients are. All of our patients pay cash for their prescriptions and consultations,” said Cottman, who runs the business as an equal partner with Green.
As its name implies, Cottman also takes the time to learn from patients what their needs are, meeting with them in a private consultation area to determine the best method for preparing a prescription for the patient based on the diagnosis and orders from the treating physician.
“If we can get patients feeling better, living longer, that’s the goal of what we do,” Cottman said. “We work with a lot of doctors in San Joaquin County and are seeing a lot of good results.”
The pharmacy is already filling about 15 prescriptions per day from its established caseload from Green Brothers, and Cottman estimates she can handle up to 50.
The pharmacy does a lot of business in bioidentical hormone replacement for women, and Cottman works with them to identify if they are having any hormone deficiencies.
Manteca gynecologist Dr. Linda Bouchard appreciates the services provided by Pacific Compounding and expects to refer several patients there, as she did with Green Brothers.
“They actually do a consult with the patient and go in-depth. I think the ability to tailor your medication dosing and delivery system is what I like about them. They really look at the individual - it’s not like one size fits all,” Bouchard said.
“You have to trust that the pharmacy knows how to measure. All the products they use are from approved (U.S. Food and Drug Administration) sources,” she said.
In addition to providing personalized care for its patients, Pacific Compounding also provides immunizations such as flu shots and pneumonia vaccines - something pharmacists have been able to administer since 1998 - saliva testing for hormones, and veterinary compounds.
In fact, one of the pharmacy’s storage cabinets holds cans of tuna fish and beef flavoring products used to administer prescription medications to cats and dogs.
Stockton veterinarian Richard Boden of Walker Veterinary Hospital regularly prescribes through Pacific Compounding.
“A lot of (human) medications that aren’t being made in animal dosages we find useful in veterinary medicine, so it’s a question of how do you get it into the animal,” said Boden, who’s been practicing for 28 years.
“There’s a whole lot of things that can be made into an ointment and applied topically. Many times it can be extremely flavored, and liquid can be squirted down. What they do has helped out a whole lot in providing alternatives,” he said, noting that much has been learned in just the past five years to change his profession’s approach to medications.
“We’re bringing a new era of pharmacy care to the community,” said Cottman, who teaches advanced compounding at University of the Pacific’s pharmacy school in Stockton.
The pharmacy school, in fact, is a nationwide leader in teaching pharmacists the art of compounding. In fact, just last year it upgraded its compounding lab with the help of $300,000 in donations from alumni.
“We’ve taught compounding for nearly 50 years,” said Nancy Deguire, assistant dean for external relations at Pacific’s Thomas J. Long School of Pharmacy and Health Sciences.
Many different methods and forms of drugs can be given that are produced at the lab
“Many of the other schools of pharmacy in California do not teach compounding and have even eliminated compounding from their courses, but we’ve actually increased our compounding courses over the years because we have found it works well for our alumni as a niche market,” she said.
Deguire said demand is growing for precision compounding, which she described as the ability to get a specific drug in a specific dose that may not be commercially available.
Nationwide, there may be roughly 350 pharmacies that exclusively provide compounding services outside of a hospital, according to the Houston-based Professional Compounding Centers of America. At least 10 times that number - or about 3,500 - provide compounding within a traditional retail pharmacy setting. And that number is increasing daily.
“It’s a trend that is just starting around the country,” said Dagmar Climo, communications director for Professional Compounding Centers, a trade association that also provides chemicals, equipment, training and education for compounding pharmacists as well as a growing number of physicians interested in learning about their increasing options for treatment.
“Especially now, with Medicare Part D taking up a huge amount of time from traditional pharmacists, compounding allows them to work closely with the patient and the physician to fill a very specific need. They don’t have to deal with insurance issues, and it gives them a way to specialize and set themselves apart from traditional pharmacy,” Climo said.
Because compounded medications are exempt by law from having the National Drug Code ID numbers that manufactured products carry, some insurance companies will not directly reimburse the compounding pharmacy, according to the trade group.
However, almost every insurance plan allows for the patient to be reimbursed by sending in claim forms.
Pacific Compounding Pharmacy and Consultations is open from 10 a.m. to 5 p.m. Monday through Friday. Cottman is assisted by pharmacy technician Donna Valverde.
“No day’s the same. You’re always learning something new here. It’s very exciting,” Valverde said.
Cottman, a graduate of the University of California pharmacy school in San Francisco, considers herself a problem solver. As a student, she won the National Patient Counseling Competition in 1996 sponsored by the American Pharmacists’ Association. One of the goals of the competition is to reinforce the role of the pharmacist as a health-care provider and educator.
As a compounding pharmacist, it’s something she gets to do every day.
Contact reporter Joe Goldeen at (209) 546-8278 or firstname.lastname@example.org
Please see pages 24 and 25 of the link above for the full text of the article.
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