Getting Custom Work Done at the Pharmacy

July 23, 2001 -- Just past his 40th birthday, Peter was taking pretty high doses of medication for his arthritis pain. They left him constipated, with a chronically upset stomach. Not a great way to live.

"He came into my store saying 'I'm nauseated, I haven't been able to sleep good, I'm a big bicyclist, but I don't even feel like doing that anymore,' " says Jonathan Marquess, PharmD, CDM, owner of Woodstock Pharmacy in suburban Atlanta.

Thus began Peter's entrée into the world of compounding -- the hand mixing of custom-made medications. A formulation for the pain medication was readily available; using pure chemicals, Marquess produced the same thing in a gel form.

Voila! "He rubbed it on the joints that were hurting him, his knees, his hips. Long story short -- he's now very happy biking with his club," says Marquess.

Reviving an Ancient Custom

Compounding harkens back to the days of mortar and pestle, to the very origins of the pharmacy profession. The practice nearly became lost during the last half-century, when the bulk of drugs became mass-produced in a one-dose-fits-all approach.

And for most people, one-dose-fits-all works just fine, says Marquess. Only in the past decade or so have pharmacists and physicians begun to realize the need for custom-made medications still exists.

"We're the medication problem solvers," Marquess tells WebMD. "Not every patient needs us. Most patients have no idea this is possible."

The art and science of compounding "is clearly accepted" by the industry's leaders, like the American Pharmaceutical Association, says spokeswoman Susan Winckler.

"When the commercially available medication is not appropriate for the patient -- when the medication a patient needs is simply not available -- that's when we need compounders," she tells WebMD. "It's one of the primary responsibilities of a pharmacist, to provide the patient with the appropriate medication."

And managed care and insurance providers are reimbursing patients for this service. "Many, many insurance companies are covering these medications," says Marquess. In fact, a compounded preparation sometimes saves money for both insurers and patients.