By Rosrin Wuithiran
Dr. Lance Campbell graduated from the University of Houston Pharmacy School in 2002. He worked for Professional Compounding Centers of America (PCCA) in Houston for a few years in their flavoring department and opened up his first pharmacy, Campbell’s Pharmacy, in 2005. He now has two pharmacies in the Houston area.
How did you first discover compounding pharmacy?
Inititally, I had wanted to become a pharmaceutical representative; they promote drugs and new lines of drugs to prescribers to help them in determining drug therapies for patients. However, during my time at University of Houston, I attended a pharmacy compounding seminar where a compounding pharmacist guest speaker spoke of his background. He told a story of using compounded capsules for wound healing, where the caretaker could open a capsule and pour an active drug onto a wound. Each capsule would hold a precise dose for the patient and that it was less painful than rubbing an ointment or liquid onto a wound. I was impressed with the problem solving involved and having to use critical thinking skills in that pharmacy setting.
What exactly does a compounding pharmacy do?
We provide medications in dosage forms and flavors that aren’t necessarily made by the major manufacturers. For instance, we can compound thyroid hormones in other strengths not made by bigger companies, so that it is easier for prescribers to titrate up or down doses to suit the patient’s needs. Other examples include converting prescriptions into beefy animal treats for cats and dogs that do not like to take pills or finding other ways to deliver medicine (such as making lozenges or flavored liquids).
Is compounding included in the pharmacy school curriculum?
Pharmacy programs usually include a semester or two of pharmaceutics which incorporates compounding in lab and course work. There are post-graduate residencies available at compounding facilities such as PCCA (Professional Compounding Centers of America) and Medisca. There are existing rotations for externships there as well for compounding and even for drug information, as they serve as consulting companies for pharmacists all over the nation who have compounding questions.
What did you do before starting up your own compounding pharmacy?
I was employed at PCCA in their flavoring department. I asked their pharmacist coordinator about available positions, and he offered me a job there. We tested new flavors for dosage forms that pharmacists inquired about.
Where could someone learn how to open and start up a compounding pharmacy?
PCCA and Medisca offer business, marketing, and sales courses. PCCA is in Houston. Medisca offers their courses in Gainesville, Florida and also at their main headquarters in British Columbia.
And these companies also supply materials and tools?
Yes, they sell equipment such as capsule machines and mixers along with active drug ingredients
What would you say would be the best tip for someone who is interested in opening up a compounding pharmacy?
Have a good sense of entrepreneurship. Learn how to market yourself and your services. Think about how your services can help a customer. Along with the compounding aspect, offer easier ways to order refills (such as our online service) and offer private consultations.
How did you advertise compounding services?
Having doctors around the area become aware of the services. Advertising in local magazines. Participating in health fairs. We have our website, www.campbells-compounding.com to help customers learn about compounding and learn what we offer.
Any advice on expectations when starting out?
Be aware that you might not make the big bucks in the beginning the way you would if you landed a retail chain position. There’s that sacrifice.
Some patients may feel apprehensive about compounded formulations due to laws and regulations.
What are the regulations for compounding pharmacy?
There was recently a landmark case that was a victory to compounders. The FDA and manufacturers questioned the validity of compounded drugs, that they should be tested as new drugs by federal law. The case’s verdict was that compounding was legal as long as it was practiced according to regulations from each respective State Board of Pharmacy.
Is compounding here to stay?
Absolutely. There was always compounding in existence. With the advent of mass-manufacturing of tablets and other dosage form in the last decades, classic compounding decreased in numbers. However, the need for compounding is pertinent for those preferring dosage forms and flavors that the manufacturers do not make. It is important to make these available to patients.
What are the benefits of operating a compounding pharmacy?
Being able to utilize your knowledge-base and critical thinking skills in ways you may have not thought of, such as helping out veterinary clinics and zoos who have a particular clientele (such as administering doses to apes, elephants, other wildlife)
What positive things have you received from your line of work?
You can really develop good relationships with patients especially if you spend time discussing their drug therapies with them.
Can you tell me of cases where a compounded drug really helped out a patient?
Our pharmacy had a pediatric patient who was unable to swallow foods due to mouth bleeds. We made a medicinal paste that helped stopped the bleeding so that she was able to eat.
Do you have advice on how pre-pharmacy and pharmacy students can get into compounding?
Ask and network. If there is not a compounding students association at your campus, ask your school about where you can find one. PCCA offers internships and workshops for pharmacy students to take during the school year and summer/winter breaks. Visit compounding pharmacies to get insight. They may even allow students to shadow and observe.
Are prescribers/doctors receptive towards compounding pharmacy?
Hormonal specialists are already familiar with hormone supplementation, such as figuring appropriate doses of progesterone for patients and such. If we can devote time to discussing availability of compounded prescriptions to prescribers, then it opens a new door for them for patients who could do better on compounded drugs that taste better, are easier to take, etc.
How did you get prescribers to become familiar with compounding pharmacy?
I did make cold calls to prescribers so that they would be aware there was a compounding pharmacy in their area that could service patients. From pain specialists, to oncologists, to pediatricians.
How do you handle insurance issues?
If you ask most compounding pharmacies, usually patients will pay the full price of a prescription and get reimbursed later by their insurances by submitting a claim form. The claim forms usually can be filled out by the pharmacy and involves entering amounts of active ingredients and costs. Sometimes, the insurance companies call pharmacies to verify active ingredients in the compounds. The patients have to research what exactly the insurances will pay.You can reach a clientele that is a cash-pay clientele, that is they have a need for compounds such as hormonal supplements, and that they are able to pay on their own.
Is your pharmacy affiliated with PCCA or another compounding organization?
Yes, our pharmacies are members of PCCA, which means we have resources from their consulting pharmacy departments and we can get supplies, ingredients, compounding classes, and tools for operations. We do utilize other suppliers as well.
Can compounding be profitable?
Yes, it does depend on your marketing skills, researching on clientele’s needs, and requires a knack for promoting services and finding solutions for patient needs. Location is a must too, that is, if there is a convenient pharmacy providing compounding services near-by, customers are more likely to inquire about using them. It is not necessarily a volume-driven setting, as prescriptions do take time to make, so you must make your profit from a smaller amount of prescriptions.
Are there any other benefits to operating a compounding pharmacy?
You are your own boss and can decide what you want your pharmacy to be, rather than having to follow corporate plans that do not match your goals. If I have a customer that is unable to pay now, we can establish an account for later pay or negotiate discount plans. The operating hours are usually shorter; you don’t have to work evenings/weekends/holidays as you might have to do in a regular community chain setting or the hospital setting. The time I can spend with my family is valuable.