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FAQS

Here is a detailed response to some of the most frequently asked questions as Atlantic Pharmacy and Compounding.

 Definition of Compounding

Prescription “COMPOUNDING” is the pharmacists’ art of preparing custom medication for the unique needs of a specific patient. It has to be on the orders of a health care professional with a license to prescribe. Its preparation has to be overseen by a licensed pharmacist in a licensed pharmacy. Unfortunately, this definition suggests that when a pharmacist prepares a custom formulation for a hospital or physicians’ office it is not legally considered a compound because it is not for a specific patient. It might even be considered “manufacturing” if done in large quantity. The term “unfortunately” is used here because there is great need for what a compounding pharmacist can provide to a clinic. In a clinic situation, certain products can be very useful but not available on a specific patient basis because the need is not realized until the patient is in the clinic. For example, Acology has prepared an LAT solution containing Lidocaine, Adrenalin, and Tetracaine. This product can be used in an office for anesthetizing skin after an injury and during suture procedures. No pharmaceutical manufacturer makes it and since a patient does not know he/she needs it BEFORE an injury, how can it be ordered and available when the clinic needs it. There are hundreds of other such examples but we will not go beyond this one. It is a problem for the medical community and regulators to solve. If you are a patient, you should not have any trouble obtaining a compounded prescription specifically for your needs.

 Prescription Requirement for Compounds

Compounding is done on an order from a health care practitioner that is licensed to prescribe. Even if the chemicals used do not require a prescription, compounding by definition requires an order from a licensed prescriber. Otherwise, it is manufacturing. Most compounding pharmacies do not have a license to manufacture – only to compound. There are some gray areas here however. If the ingredients are available by prescription only, the usual prescription order for a compound is required. If the ingredients are available without a prescription but are classified as drugs, then again a prescription is required. Any chemical that “modifies body function or structure” is considered by the FDA to be a drug. They may be OTC (over the counter) and not require a prescription, but are still a drug. Therefore, they can either be prepared as a compound by prescription or by manufacturing which requires FDA manufacturing permits and licensure. However, if the ingredients are considered “natural” and are not considered drugs, you could make up the mixture in your own kitchen sink and sell it. (Many companies take advantage of this unregulated area of manufacturing so be careful). The gray areas regard natural drugs. Progesterone for example is a drug. It carries a federal legend and is USP (United States Pharmacopoeia). It modifies body function (can regulate menses, pregnancy etc.) However, many companies are selling it without a prescription because it is “natural”. The product strength is usually very low so as to not affect a body function that they might later be held liable for if something goes wrong. But if the strength is low enough to not affect body function is it of any value? If it does not affect body function does it actually have any progesterone in it at all???? Our advice is to go through the added effort to obtain medications from a licensed compounding pharmacy with the approval of your other health care providers.

 Obtaining a Compounded Prescription

We are here to provide you with your next prescription that requires compounding. It is quick and easy to become one of our patients. We need the following: (all of which can be faxed or called in by telephone). Patient Name Date of Birth Address (complete) Phone Number (home and daytime if different) Allergies Credit Card #.

And of course we need the order from your practitioner. This can be called in, faxed, e-mailed or mailed. In most cases, we will have to call to verify the Rx but that is just a regulatory formality that we can take care of.

Hopefully, this website will offer a lot of the information that your practitioner needs to create an order for you. However, we are always available to help consult with your prescriber (via e-mail or toll free telephone) to help him/her to write the correct order for you. You might be able to help him or her by printing some of the pages from this site that pertains to your needs. Our information regarding Bio-identical Natural Hormone Replacement Therapy could be of great help if that is what you need.

 Resistance and Turning the Tides of Conventional Wisdom

Some physicians are a little slow to come around. They like the “evidence” presented by the sales reps of the big drug manufacturers. We respect that. However, considering how many pharmaceutically manufactured drugs have been withdrawn from the market due to safety issues, one must wonder about all that great evidence that was paid for by the manufacturers. Not to mention retracted claims. No drug therapy is perfect and safe for everyone. Physicians need to feel comfortable with what they are ordering. If you have a different practitioner order a compounded prescription for you, let your regular one know what you are doing. In all but a few rare cases, they will want to watch and monitor your results. Given time and good results, your practitioner may come around and want to start ordering for you and their other patients. It’s another way to spread the good word.

 Cost Issues

Prescription compounding typically costs a little more than manufactured prescriptions. Sometimes a lot more- depending on complexity, availability, equipment required to prepare and time spent on research and development.

Fortunately, most health insurance companies recognize the value of compounded prescriptions and the expected long term outcome they can offer. If a compounded prescription is better tolerated there will be better patient compliance and therefore more effective treatment. Compounding allows a practitioner to offer dosage form and strength that is best for an individual patient. The concept of one-dose-fits-all is for the convenience of large pharmaceutical companies, not for the patient. Think about it- is it reasonable to think that a 100 pound 50 year old should have to take the same dose as a 135 pound 35 year old? Should a patient be forced to take a product that is potentially harmful in some respects but helpful in others? Not if there is a better solution to be had through compounding. Compounding can save health care dollars in the long run by helping patients be healthier.

Back to pricing. Pharmaceutical manufacturers have the ability to mass produce large quantities of the same product. Economy of volume plays into this. Compounded medications are tailored to each individual. In our practice, we have prepared hundreds of different strengths and combinations of estrogen, progesterone and testosterone. The most frequently prescribed pharmaceutically manufactured estrogen (Premarin) comes in 4 strengths with 2 variations in combination. There is no way a compounded estrogen in its many forms and combinations can be produced for the same amount of money. How much more? A monthly course of combination estrogen + progesterone + testosterone costs between $45 and $100 or more depending on strength, dosage form, ingredient choice and ratio and delivery device. If price is an issue, talk to us. We can suggest ways to trim expense. For example (again with natural hormones) a sublingual drop can be much less expensive than an absorption enhanced cream because of inactive ingredient cost, time to prepare, and lower necessary strength of active ingredients. If price is not an issue, lets try for convenience, accuracy, therapeutic results and least amount of side effects. IT IS DIFFICULT TO PUT A PRICE ON HEALTH AND WELL BEING.

 Talk to a Pharmacist

We offer a toll free number that you can use to call in refills, ask questions, and even talk to a pharmacist. If you would like to talk to a pharmacist, you will need to call between 9AM and 5PM Monday thru Friday. Although we pharmacists love to talk to our patients, we do need to work on our compounds so please be patient with us if we need to call you back to consult with you. Our number is 954-366-6519.

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