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Demand for Compounded Prescriptions Increasing Among Ob.Gyn. Patients.

If Maria Ahlgrimm's workload at Madison Pharmacy Associates in Wisconsin is any indication, the demand for individually compounded prescriptions for women is definitely on the rise.

"Eight or nine years ago, I was getting 2,000-3,000 calls a month" for prescriptions or women's health information, she said. "Now we get 2,000-3,000 calls a day."

Ms. Ahlgrimm reflects what appears to be a growing interest among ob.gyn. patients in having their prescriptions made up especially for them, from ingredients that may not otherwise be available in the form or dosage that they feel they require.

"We've seen not only an increased interest from the consumer in having more choices, but an increased understanding of the need for choice versus one size fits all," said Ms. Ahlgrimm, who is a pharmacist and founder of the pharmacy, which specializes in compounded prescriptions.

Shelly Capps, executive director of the International Academy of Compounding Pharmacists, in Sugar Land, Tex., estimates that compounded prescriptions represent about 1%-2% of the total prescriptions dispensed each year in the United States, and she expects that number to increase.

And compounded prescriptions are a very lucrative business. Compounding as few as five prescriptions per day can double or even triple the average profit of a pharmacy according to a recent article in American Druggist magazine.

"One reason to compound is that it can solve patient problems," said Ms. Capps. "But it also distinguishes pharmacies within the marketplace and makes them different from other pharmacies."

At Madison Pharmacy Associates, Ms. Ahlgrimm compounds things like natural progesterone combined with natural estrogen for hormone replacement in menopause. Estriol vaginal suppositories to relieve vaginal dryness are another large seller, as are progesterone sustained-release tablets--used to treat infertility, menopause, and premenstrual syndrome--which aren't available in the United States except from a compounding pharmacy.

Most of the physicians the pharmacy works with are ob.gyns., and most of the prescriptions are covered by insurance companies, she said.

Dr. Klaus Diem, an ob.gyn. with the Physicians Plus division of UW Health, a university-owned health plan in Madison, said he began prescribing individually compounded prescriptions because patients were interested in them. "There are patients who don't tolerate `traditional' medications for a variety of reasons," said Dr. Diem. "Looking for an alternative is a safe approach."

Dr. Diem said most of his individually compounded prescriptions are used to treat postmenopausal symptoms, such as hot flashes. He also has used them to treat abnormal uterine bleeding and to support early pregnancies with hormone deficiencies. Many of the products he uses come in a cream form, which is good for patients who don't like pills or injections.

Dr. Joe Martorano, a New York psychiatrist who treats a number of patients with PMS, said he uses compounded prescriptions such as natural progesterone because the synthetic version "seems to [generate] erratic reactions. Synthetic progesterone is contraindicated because it vies for the same receptor sites in the brain [as natural progesterone] and has the paradoxical effect of driving the natural progesterone down and causing an exacerbation of symptoms."

Although the number of compounded prescriptions appears to be growing, physicians are facing some pressure from pharmaceutical companies that want doctors to buy their products, Dr. Martorano said. "Pharmaceutical companies have their money and their advertising in synthetics, and they besiege you with detail people."

Nonetheless, Dr. Diem thinks more and more ob.gyns. will be looking toward individually compounded prescriptions for their patients.

"Ob.gyns. are moving in the direction of trying to satisfy their patients, and they are not being as dogmatic about what might or might not work," he said. "There's been a greater interest in alternative medicines, and this is along those lines."

Recently, the Food and Drug Administration has also taken a special interest in compounding. As part of the FDA Modernization Act of 1997, Congress ordered the agency to develop a way to better regulate compounded prescriptions that were being shipped across state lines. In response, the FDA issued a "memorandum of understanding" late last year that banned such interstate shipments.

The FDA received numerous comments in response to its memorandum and is still evaluating them, according to an agency spokeswoman. A final version of the memorandum is expected by the end of this year.
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Publication:OB GYN News
Article Type:Brief Article
Geographic Code:1USA
Date:Oct 1, 1999
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