Compounding pharmacies — when standard medications don't work

This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.

Your parent desperately needs a medication, but they can't swallow pills. The manufacturer makes it in tablets only. The medication isn't available as a liquid. You're stuck between a health need and a physical inability to take the treatment. Or your parent takes a medication that gives them terrible side effects at standard doses, but a slightly lower dose would work better. The manufacturer doesn't make that specific dose. You're stuck again.

These are exactly the situations where compounding pharmacies exist. Compounding means custom-preparing medications to meet specific needs. A compounding pharmacist starts with the basic medication ingredient and creates a form that works for your parent. A pill becomes a liquid. A standard dose becomes a custom dose. A medication with a taste that makes someone gag becomes something palatable. When standard medications don't work, compounding pharmacies offer solutions.

What Compounding Actually Means

Compounding is the practice of preparing, mixing, and customizing medications. A compounding pharmacist takes pharmaceutical ingredients and creates medications in specific forms, flavors, strengths, or combinations to meet individual patient needs. It's an old profession that's gained new importance as we realize how many people can't use standard medications.

All pharmacies compound to some degree. When a pharmacist mixes an antibiotic powder with water to make a liquid, that's compounding. When a pharmacy takes a standard medication and puts it into a compounded form, that's compounding. What distinguishes compounding pharmacies is that they focus primarily on customization. They have equipment and expertise specifically designed to create custom medications.

Compounding requires a prescription from your parent's doctor just like any other medication. The doctor writes what the medication should be, what form it should take, what dose, and any special requirements. The compounding pharmacist then creates it.

When Compounding Solves Real Problems

Swallowing difficulties are the most common reason to use compounding. As your parent ages, swallowing pills becomes harder. Arthritis makes it difficult to hold small objects. Conditions that affect swallowing make pills dangerous. Some people forget they need to take pills and hide them in their mouth. A medication that's a liquid goes down more easily. It can't be hidden. It's easier to confirm that your parent actually took it.

A compounding pharmacy can turn almost any medication into a liquid. The medication is dissolved or suspended in a liquid base. A flavor can be added to make it taste better. Many liquid medications taste bitter or bad. Compounding pharmacies can add flavors like cherry, chocolate, or mint to make medications more palatable.

Dosage flexibility is another key reason for compounding. Your parent's doctor might determine that their standard dose is too much. They need a lower dose. The manufacturer makes the medication in ten-milligram tablets, but your parent needs eight milligrams. A compounding pharmacy can make an eight-milligram liquid or a smaller tablet. They can create the exact dose the doctor prescribes.

Sometimes your parent takes multiple medications. A compounding pharmacy can combine medications into one dose. Instead of taking three pills at breakfast, your parent takes one pill that contains all three medications in the right doses. This simplifies medication taking and improves adherence.

Medication combinations can also address side effects. If your parent reacts badly to a standard medication, the doctor might want to use a lower dose combined with something else. A compounding pharmacy can create that specific combination.

People with severe allergies to ingredients in standard medications sometimes need compounded alternatives. If your parent is allergic to dyes, fillers, or other inactive ingredients in commercial medications, a compounding pharmacy can create a medication without those ingredients.

Practical Considerations About Compounding

Compounded medications cost more than standard medications. You're paying for custom preparation. A standard medication might cost ten dollars. The same medication compounded as a liquid costs thirty or forty dollars. That's real money. Your parent's insurance might not cover compounded medications because they're considered customized rather than standard.

Before pursuing compounding, confirm with your parent's doctor that a standard medication won't work. Ask the pharmacist whether a less expensive option exists. Sometimes a different standard medication accomplishes the same goal at a fraction of the cost. Compounding should be a last resort, not a first choice, primarily because of cost.

Insurance coverage for compounded medications is inconsistent. Some insurance plans cover them, especially if there's a medical reason that standard medications don't work. Others don't cover them at all. Before investing in a compounded medication, confirm with your parent's insurance whether coverage exists. If it doesn't, understand the full cost before proceeding.

Some compounding pharmacies are highly regulated and maintain excellent quality standards. Others cut corners. The pharmacy you choose matters enormously. Look for pharmacies that are state licensed and preferably accredited by organizations like PCAB (Pharmacy Compounding Accreditation Board). Ask whether the pharmacist is highly trained in compounding. Ask about their quality control processes. A compounded medication made poorly isn't just expensive, it's potentially dangerous.

Finding a Compounding Pharmacy

Ask your parent's doctor for a referral to a compounding pharmacy. Doctors who recognize the value of compounding often have relationships with high-quality compounding pharmacies. A doctor's referral is probably your best starting point.

You can search online for compounding pharmacies in your area. Look for accreditation or certification. Read reviews. Call and ask about their experience with your parent's specific medication needs. A pharmacy experienced in compounding medications for geriatric patients is ideal because they understand the particular challenges older adults face.

Talk to your parent's regular pharmacy. Some chain pharmacies have compounding capabilities. If not, they can refer you to a compounding specialist. The relationship between your parent's regular pharmacy and a compounding pharmacy can be helpful because records are shared.

Working With a Compounding Pharmacist

Once you've found a compounding pharmacy, the first step is a detailed consultation with the pharmacist. Your parent's doctor writes the prescription. The pharmacist then discusses with you and your parent what form works best, what flavors might help, what dosages are needed. This conversation is a collaboration.

The pharmacist needs to know everything about your parent. What can they actually swallow? What tastes do they like and dislike? Are they allergic to anything? What medications are they already taking? What time of day does the medication need to be taken? All of this affects how the medication is compounded.

The first compounded medication takes longer to prepare because everything is custom made. Follow-up doses are faster because the pharmacy has already done the work. Costs might be lower on refills too because setup time has been invested.

A quality compounding pharmacist will also monitor how your parent is doing on the compounded medication. Are they taking it? Is it working? Are there side effects? Are there adjustments that would help? A good compounding pharmacist isn't just making pills. They're part of your parent's healthcare team.

Quality Control and Safety

Compounded medications are required to meet the same safety and purity standards as manufactured medications. But enforcement is inconsistent. A reputable compounding pharmacy has rigorous quality control. They test their finished medications. They maintain records of where ingredients came from. They follow strict procedures for preparation.

Before your parent uses a compounded medication, ask what quality control measures the pharmacy uses. What testing do they do? How do they ensure purity and potency? Do they have third-party testing? A pharmacy confident in their quality will answer these questions readily.

Watch how your parent responds to a compounded medication. If they show unusual side effects or if the medication doesn't seem as effective as expected, tell the pharmacist. They can test the medication to make sure it's correctly prepared. Sometimes the issue is the compounding. Sometimes it's just that the medication needs adjustment.

Insurance and Financial Assistance

Before ordering a compounded medication, contact your parent's insurance company. Explain the medical reason for compounding. Ask whether it's covered. Get this in writing if possible. Some insurances will cover compounding if there's documentation that a standard medication won't work.

If insurance doesn't cover the medication, ask the compounding pharmacy about payment plans. Some offer them. Ask whether your parent qualifies for pharmaceutical assistance programs. Some programs help pay for compounded medications, though availability varies.

If cost is prohibitive, explore with the doctor whether any standard medication could work instead. Cost isn't always the final answer, but it's a real consideration.

Compounding as a Bridge, Not Forever

Think of compounding as a solution for a specific problem. Your parent can't swallow pills now, so a liquid works. But as their situation changes, revisit the need. If your parent's situation improves, they might be able to return to standard medications. If it worsens, they might need different solutions. Compounding is flexible and can adapt as your parent's needs change.

Advocating for Your Parent

Your parent might feel embarrassed about needing a custom medication. They might worry about cost or inconvenience. Your job is to help them understand that compounding exists for people like them. There's nothing strange or wrong about needing a customized medication. It's a tool that makes healthcare possible when standard approaches don't work.

How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. Decisions about compounding medications should be made with your elder's healthcare provider and pharmacist, who can determine whether compounding is appropriate and monitor its effectiveness.