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Some Pharmacists Making Own Medicine

July 28, 2003

ORD, Neb. (AP) _ From the shelves of over-the-counter medicine to the Russell Stover candy display, there’s not much to distinguish the Good Life Discount Pharmacy from most other small-town drug stores.

That is, until you see the 11-foot-by-50-foot laboratory downstairs.

It’s here that two pharmacists and three technicians are doing the work that big pharmacies don’t want to do, or don’t have time to do. In this stark white and brightly lit room, pharmacists use traditional tools like the mortar and pestle _ albeit now computerized _ to make customized medicines by hand for their patients.

``We have tried to find a niche,″ said co-owner Angie Svoboda, one of the pharmacists. ``There’s a need out there, and we capitalized on that need.″

Most people picture their pharmacy as the corner chain store that dispenses pills mass produced by drug companies.

``Their whole service is to fill as many darn prescriptions as they possibly can because that’s their profit,″ said Jim Andreesen, Good Life Pharmacy’s other pharmacist and co-owner.

But when it comes to medicine, it’s not always a one-size-fits-all situation, and that’s where compounding pharmacists come in.

There are patients who have specific medicinal needs that are not met by the mass-produced market. Often, doctors will consult with a compounding pharmacist to tailor a medical compound for the patient.

For example, there are numerous over-the-counter hormone therapy medicines for women. ``But not every product works perfect for that woman, or that woman has side affects, or it doesn’t work for her needs,″ Svoboda said.

Instead, a compounding pharmacist will take the pure powder form of the hormone and custom-make a medicine for the patient according to her doctor’s specifications.

The possibilities of customized drugs are unlimited. Pharmacists here have added chocolate flavoring to a child’s antibiotic to make it more palatable. They have made topical pain creams specifically designed for specific parts of the body. They even have made nicotine lollipops for people trying to quit smoking.

``They are simple things to do, but it can go all the way up to making stuff for patients that’s not commercially available,″ Andreesen said.

Such work is the birthright of pharmacy, said Patricia Paget with the International Academy of Compounding Pharmacists, based in Sugar Land, Texas.

``It is very consumer-, patient-oriented,″ she said. ``We just ultimately want to get something to them that is tailored for them.″

It’s estimated that compounded drugs account for 1 percent of all prescriptions filled in the country.

That means in 2001, there were 30 million compounded prescriptions, which brought in more than $1.6 billion, Paget said.

There are about 24,600 independent pharmacists in the United States, of which 82 percent offer some type of compounding service, from only adding flavoring to a child’s medicine to reproducing drugs that companies are no longer making, Paget said.

``It fills an important need. For many patients, it may be only way to get the drugs they need,″ said Susan Winckler of the American Pharmacists Association.

Among Nebraska’s 1,600 or so practicing pharmacists, only about 20 perform compounding services on the scale of those at Good Life Pharmacy, said Joni Cover with the Nebraska Pharmacists Association.

That figure does not include hospital pharmacies, where the practice also is prevalent.

Compounded drugs are just as safe as mass-produced drugs even though they are prepared differently, Winckler said.

``Advancements in technology and the equipment used has helped pharmacists improve the precision in preparing compounded medications,″ she said. ``If the recommended care is exercised, errors are minimized.″

No studies have been conducted on error rates among customized drugs vs. mass-produced drugs, Paget and Winckler said. However, the International Academy of Compounding Pharmacists has established a foundation that will fund that sort of research.

Compounding was the normal practice in most pharmacies until mass manufacturing of medicine became commonplace after the 1950s.

``The old way of compounding was mortar and pestle, and your ointment slab and your Bunsen burner, and it wasn’t a fun thing,″ Svoboda said. ``That’s why pharmacists sort of gave up compounding, it was too hard.″

It has come back into favor in the last 20 years because new equipment, much of it computerized, has been developed to make the practice easier.

And the Good Life Pharmacy is taking full advantage of it.

Posted just outside its downstairs laboratory is a Nebraska map overflowing with stick pins marking the hometown of every patient that’s had a compounded prescription filled by the Ord pharmacists.

They serve about 1,500 patients a month, making on average 20,000 pills a month.

Most of their business comes from either doctor referrals or word-of-mouth between patients. However, those people have to be sent back to their doctors before any medicine can be made.

In Nebraska, state law requires anything to be compounded by a pharmacist to be by prescription only.

Insurance usually covers about 80 percent of these prescriptions, but sometimes not without a fight, Andreesen said.

Other prescriptions even come in from other pharmacies. Andreesen recently completed five orders from a nearby national chain store that doesn’t compound.

``We need to help patients, and doctors need to have pharmacists available to do that,″ Andreesen said. ``Chain stores can’t take the time, and independent pharmacists have sort of stepped up.″


On the Net:

Good Life Discount Pharmacy: http://www.goodliferx.com/index.html

International Academy of Compounding Pharmacists: http://www.iacprx.org/

Nebraska Pharmacists Association: http://www.npharm.org/

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