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Summary – Compounding Pharmacist

Compounding pharmacy is a practice of pharmacy that requires greater focus on the various dosages and mediums that medications can utilize. While manufacturing has allowed for greater mass distribution, there are patients who are allergic or intolerant to inactive ingredients used who can greatly benefit from a more customized medication. Additionally, the ability to change the method of delivery can be of great benefit to those unable to swallow pills, such as infants needing a proton pump inhibitor to treat reflux  or an animal who requires a dosage that would be impractical to administer using forms available to humans for example. Because of this need for patient customization, compounding pharmacy is a field that demands great patient interaction, technical skill, and a solid foundation in pharmacy calculations. Many chain retail pharmacies are ill equipped to compound medications beyond a simple extemporaneous mixture of liquids. Additionally, the basic skills needed are considered core curriculum for pharmacy students, but students wanting more advanced study might have to pursue advanced compounding electives, or training from an outside organization.

Due to the level customization, compounding pharmacists must be intimately familiar with the needs of the patient. This includes allergies, preferred dosage forms, specific dosages needed, etc. With the amount of specificity used, the pharmacist must also be aware of how dosage forms will be absorbed and any potential interactions or problems that could occur. It is because of this that the pharmacist must be able to not only counsel on the medication, but also on how to properly utilize the custom dosage form to ensure the full medical benefit. Furthermore, a strong relationship with the patient is required as they are trusting that a custom medication dose will be both safe and effective since they will be unable to use commercially available medications. Additionally, a compounding pharmacist is responsible for ensuring the compounding room meets specified requirements. This can mean ensuring proper sanitation, temperature, humidity, air flow, etc. Typical tasks can also include developing new formulas to be used and reviewing preparations made by technicians

Responsibilities of a Compounding Pharmacist

Your average “compounding pharmacist” should spend little of their time engaged in the technical aspect of compounding, however that doesn’t mean that they shouldn’t have a baseline level of competency. The technical aspects of compounding are usually best left to — you guessed it, your technicians. As with any technician work, a pharmacist is usually the final check before dispensation to a patient.

Pharmacists must ensure that all compounding practices adhere to regulations as presented in the most recent editions of USP General Chapters <795> for non-sterile compounding, <797> for sterile compounding, and <800> for handling of hazardous drugs including but not limited to : 

• Environmental monitoring
• Training of personnel
• Quality control
• Appropriate storage and handling of chemicals and finished compounded medications
• Adverse event tracking

In addition to regulatory duties, compounding pharmacists are tasked with development of formulations and ensuring the chemical compatibility/stability, and mathematical accuracy of the formula. These formulations are typically developed to meet patient specific needs. The need for patient counseling is paramount in the compounding space. Because patients may be using medicines in novel dosage forms or for rare conditions, it is of utmost importance that they be appropriately counseled on the purpose of their medication as well as correct administration and disposal. Additionally, because medications may be used for indications that are different to their conventionally manufactured forms, it is imperative that the pharmacist keep abreast of the ways that compounded medications can be used to help their patients. An example that comes to mind is a compounded topical preparation of diltiazem and bethanechol. Medicines traditionally administered orally for hypertension and urinary retention, when administered together in a topical formulation are used to decrease anal sphincter pressure and heal anal fissures. 

Lastly, it helps for a compounding pharmacist to be a forward thinker with an entrepreneurial mindset. In the environment we live in, drug shortages are a daily obstacle that pharmacists grapple with. A good compounding pharmacist would keep their finger on the pulse of incipient shortages so that they can potentially offer compounded medications to meet the market need. 

Compounding Pharmacist Job Requirements

Because of how widespread the need for custom medications is, the skills needed to learn basic compounding is considered core curriculum for those currently in pharmacy school. During their education, students are taught proper compounding techniques and the knowledge required to create basic compounded medications. 

Currently no state requires specialized training, however there is no shortage of organizations that offer it. Pharmacists that work in sterile compounding are able to obtain board certification from the Board of Pharmacy Specialties as a Board Certified Sterile Compounding Pharmacist. They can also pursue more advanced training offered through pharmacy compounding wholesalers. Pharmacies as an entity can become accredited through the Accreditation Council for Health Care’s (ACHC) Pharmacy Compounding Accreditation Board (PCAB), or the National Association of Boards of Pharmacy’s (NABP) Compounding Pharmacy Accreditation.

Salary of a Compounding Pharmacist

Currently, the average salary for a compounding pharmacist is approximately $115,000 per year. While this average is lower than the national average of pharmacist salary, individual salaries can fluctuate between as high as $140,000 per year and as low as $80,000 per year. However, the majority of salaries for compounding pharmacists tends to not veer outside a $20,000 difference which can indicate that there is not as much opportunity for career advancement. However, given the lack of extensive postgraduate training requirements as well as the widespread use of compounding, it is fair to say that there is decent demand for compounding pharmacists. Additionally, compounding allows for moving into various other fields, for example one could be compounding primarily for oncology.

Pros and Cons of Being a Compounding Pharmacist

When it comes to compounding, a major satisfaction in the work stems from the ability to provide for patients that do not have widely accessible medications. The field also rewards those who would consider themselves extroverted due to the importance of the patient relationship. In a survey done by APhA, many compounding pharmacists listed interaction with patients as the most appealing aspect of the field. Those who enjoy organization and utilizing evidence in their tasks will enjoy the technical aspects of the field, as they look for proper forms medications can be taken as and formulas for compounds not typically utilized.

However, with this comes the challenge of working with patients that may have more specialized needs. Additionally, concerns are raised that due to the specificity entailed in compounding leads to a lack of desirable reimbursement from third-party payers. After the tragedy at the New England Compounding Center in 2012 where over 50 people died of fungal meningitis due to improper sterilization, oversight has significantly increased from both state and federal regulators. 

How to Stand Out as a Job Candidate in a Compounding Pharmacy

When it comes to entering this specialty, a vast majority of pharmacists are able to compound at a basic level and so it is in the best interest to stand out amongst the competition. While no state demands specific postgraduate training, there are continuing education programs offered by various organizations such as the Professional Compounding Centers of America that can offer new knowledge and techniques that can set someone apart. Additionally, one can pursue various certifications that can display one’s knowledge and drive, an example being the ASHP compounding certificate. Experience in a compounding pharmacy can be of great benefit as well in addition to knowing other compounding pharmacists and heeding their advice on entry in the field. Having a strong understanding of various drug monographs and regulations will also increase one’s potential as one would be starting with a strong understanding of two important aspects that come with success in compounding. 

Special thanks to Sam An, PharmD, student pharmacist Evan, Michael Freudiger, PharmD, and Alex Barker PharmD

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Citations:

What is Pharmacy Compounding| Compounding Pharmacy Near Me – 

http://www.pccarx.com/AboutUs/WhatisCompounding

Compounding Pharmacist Annual Salary ($115,460 Avg | Jul 2021) – 

https://www.ziprecruiter.com/Salaries/Compounding-Pharmacist-Salary

Salary: Pharmacist – https://www.glassdoor.com/Salaries/pharmacist-salary-SRCH_KO0,10.htm

Alliance for Pharmacy Compounding – What is Compounding? – https://a4pc.org/APC/About/What-is-compounding-/APC/About/What-is-compounding-.aspx?hkey=3822cc79-8504-48c2-9579-2e9ff57a5c72