So your doctor has decided to prescribe hormones to treat your menopause symptoms and to help reduce some of the risks that accompany the decrease in blood hormone levels. The next step is pretty simple.
You get your prescriptions filled and start taking them. Right?
But there’s a bit more to it than just that.
Your pharmacist is a health care professional, a key member of the healthcare team that takes care of your health and the health of your family. You don’t choose your physician based solely on the price of an office visit, do you? I suggest that you take a close look at the pharmacy you choose to fill your prescriptions and consider a few questions about your pharmacy and your pharmacist.
Does your pharmacist ask the right questions? When you take a prescription to the pharmacy, your pharmacist is required to find out your medical history, your allergies, any disease states or medical conditions you may have and especially any medications you may already be taking. Sure, that question/answer session takes a little time, but it’s an important piece of your healthcare puzzle that your pharmacist needs to document. If your pharmacist does not ask those questions, they won’t have the big picture about you and your health status and the lack of that information may come back to bite you later. If you have had an anaphylactic (severe allergic) reaction to peanut butter that put you in the ER and you have been prescribed commercially-available Progesterone 100MG capsules, your pharmacist would need to know about your allergy so that you don’t have a life-threatening issue with the peanut oil that those capsules may be filled with.
Does your pharmacy provide the type of hormones your doctor has prescribed? Pharmacists fill prescriptions for hormones every day. But some hormone prescriptions are a bit more specialized and not every pharmacy will be able to provide every hormone prescription. If your physician has prescribed Estradiol 1MG tablets and Medroxyprogesterone 5MG tablets, you can get them at your local CVS, Rite-Aid or Walgreen’s. If your gynecologist writes a prescription for Estradiol 0.25MG dye-free, lactose-free capsules, Progesterone 75MG sustained-release capsules and Testosterone 5mg/gm lipoderm cream, you will need to go to a specialized custom compounding pharmacy to get those filled. Rite-Aid will not have the equipment, the training or the chemicals necessary to compound those prescriptions for you. If your doctor prescribes compounded Estradiol 0.025% Ophthalmic Solution (sometimes prescribed for severe dry eye related to menopause) you’ll have to go to a compounding pharmacy that specializes in sterile compounding, which requires an even deeper level of specialty experience, training and equipment. Ask your doctor or your pharmacist about your hormone prescriptions and what pharmacy would be best to fill them.
If your doctor prescribes compounded prescriptions, does the compounding pharmacy meet quality standards? Compounding pharmacy has been around for centuries, long before there were big pharmaceutical manufacturers making millions of tablets and capsules and selling them in bulk. As recently as a hundred or so years ago, the pharmacist would receive a hen-scratched prescription and decipher the doctor’s instructions to mix up a recipe (abbreviated “Rx”) for the medication the doctor wanted the patient to take. The doctor trusted the pharmacist to take care of the patient, based on his instructions. The patient was trusting the doctor and the pharmacist to work as a team to treat her health issues in the most appropriate manner. This Doctor-Patient-Pharmacist relationship is at the core of healthcare and is central to the quality practice of compounding pharmacy. If there is no direct relationship between these three individuals, the quality of compounding pharmacy MAY be compromised.
There are several questions you could ask regarding the quality of a pharmacy but most issues stem from this triad relationship.
- Does the pharmacy participate in an accreditation system? Most will require a triad relationship.
- Does the pharmacy test its compounded preparations periodically for potency?
- What happens if a test shows an issue with a drug? Do they institute a recall?
- Does the pharmacy meet or exceed applicable United State Pharmacopeia (USP) standards for compounding? Most states require compounding pharmacies to meet USP compounding standards.
- Does the pharmacy have a Continuous Quality Improvement system to correct problems and make the pharmacy get better and better over time?
- Finally – Does the pharmacist CARE about you as a patient?
You could also ask this last question in terms of “customer service.” Do you experience courteous, helpful and positive interactions with the pharmacist and pharmacy technicians at the pharmacy, whether you speak to them on the phone or in person? Is there a sense that your health is their highest concern? There’s plenty of competition out there and there’s no reason you need to settle for poor customer service or pharmacists and technicians who are too busy or impatient to answer your questions. be a good patient and don’t monopolize your pharmacist’s time, but expect a level of professionalism from your pharmacy or find one that gave it to you.
Because pharmacies are run by human beings, no regular or compounding pharmacy or pharmacist is perfect. We all have our strengths and weaknesses. Find the pharmacy that cares for you in a way you are most comfortable. Be careful not to judge a pharmacy by price alone. There are a lot of other factors, including insurance contracts, to consider. Talk with your doctor and your pharmacist to determine which pharmacy is the best one to fill your prescriptions.