Some compounding pharmacies fill needs Big Pharma passes over
CHAMPAIGN — Compounding pharmacists don't just customize drugs for individual patients with special needs.
As pharmaceutical companies have stopped making some products, compounding pharmacists have played an increasingly important role helping fill in drug gaps.
There are more than 200 medications currently on the American Society of Health-System Pharmacists' drug shortage list, and these shortages pose problems not only to individual patients but hospitals and clinics that need supplies on hand.
The New England Compounding Pharmacy supplied several local hospitals and clinics — among them Sarah Bush Lincoln Health Center, Provena Covenant Medical Center and Carle Physician Group — with some of its products not involved in the multistate meningitis-related outbreak.
"Every hospital in America is buying from one of these outsourcing pharmacies," said Mike Craig, Sarah Bush Lincoln's director of pharmacy services.
Given the NECC-linked meningitis tragedy, he said, Sarah Bush Lincoln is being "ultra-cautious" moving forward with those purchases.
But, he added, "you run the risk of not having the medication a patient needs versus looking for an alternative source. We have to be able to adapt, and there should be no patient safety issues for us."
Covenant and Carle say they also fill some supply needs with products they buy through other compounding pharmacies.
Carle deals with three of them, two in Chicago and one in Peoria.
One supplies a high-use drug that isn't commercially available and for which Carle's own pharmacy staff can't keep up with the demand; another supplies a commercially unavailable drug that requires high-risk compounding that Carle's facilities aren't rated to perform, said Carle spokesman Sean Williams.
Illinois law permits drug compounders to sell products to be used by practitioners in their offices for use with patients.
State law also allows sales to clinics and hospitals in anticipation of receiving a prescription or order for those drugs, based on their routine dispensing patterns.
The patient-prescription relationship still remains, Carle pharmacy director Linda Fred said. But the drug is already on hand, the prescription is applied when the patient needs it, and the compounding center is notified of the lot number and required patient information at that time.
"That's how it works out sometimes," she said.
One of the compounding pharmacies that supplies Carle, Alwan Pharmacy and Compounding Center in Peoria, prepares an injectable progesterone for pregnancy issues which patients bring to their doctor's offices to administer, Williams said.
Alwan owner Mike Minesinger says he operates a sterile compounding lab at one of his two locations. It's a window-enclosed area in plain site of his customers, "kind of like an open kitchen."
Minesinger acknowledged sterile compounding isn't for pharmacists unwilling to make the investment in training, equipment and testing.
But he's found a market for it. And while he may be selling outside his community, he said, the patient-doctor-pharmacist relationship compounding pharmacists revere is equally important to him.
"I may not know that patient, but I know enough about that patient to be able to provide that medicine," he said. "I know it's for a particular patient. I'm not making a gallon of it and shipping it out."
Most compounding pharmacies in the U.S. are serving local communities, but there is a role for those serving wider areas, said Stephan Beek, spokesman for Professional Compounding Centers of America.
Laws vary by state, but nearly all states allow for compounding drugs sold in anticipation of need, he said.
Making larger batches of a drug compound can save time and money and reduce errors in compounding, Beek said.
But the need for the patient prescription remains, he stressed.
"You can have a hospital that may have a need for 10 compounds in a day, but each of those 10 should have a prescription behind it," Beek said.