Killing Your Grandparents
To say that big Pharma has far too much power in medicine today would still be a gross understatement. Their influence over policies and prices and availabilities is near infinite and they are some of the biggest companies in the world at this point. If you look then at their heritage it started with bottles of raw materials and men and women mixing together medications for patients in specialized and unique formulations for each patient. They would take these compounds and blend them together and have now become known as compounding pharmacies – they used to be called just pharmacies. They still exist in very small niches across America. However, their existence is under direct attacks from big Pharma as they have been able to influence government agencies and regulatory companies as well.
Over the last five years, a change has been made with the schedule 2,3,4, and 5 medications so that it is illegal to have these prescriptions written on a prescription pad and given it to the pharmacist. Even so-called triplicate prescriptions are no longer legal, at least in Texas and I assume across all states although I did not research that. But here in Texas at least all scheduled medications must be sent via electronic prescription through the SureScripts clearinghouse. This of course means that every prescription has an NDC number that allows it to go through the clearinghouse. Without it it will not go through. Compounding pharmacies can compound many drugs. Injectable and oral and creams and topicals and all sorts of medications. One of the better uses of compounding medications from my perspective has been specialized versions of testosterone. I have used in patients orally disintegrated testosterone tablets, testosterone in injectable forms with different oils that are not available commercially, and testosterone in topical forms that can be used on skin or on female genitalia with very good effect. Sometimes combined with estrogen, they are a useful adjunct for care.
However, testosterone is a scheduled medication. Since that medication cannot be sent electronically it has to be sent at this time via fax which I accomplish through electronic means. So literally there is no legal way for a testosterone prescription to be sent to a compounding pharmacy. Fax is and always has been equivalent to telephone prescription and that is not sufficient as directly stated in the law. Therefore, these regulatory agencies under the pressure of big Pharma have given no quarter to compounding pharmacies and they have no choice but to literally break the law every time they fill a prescription for a scheduled medication. At this time nobody is calling attention to this conundrum and at this time nobody is prosecuting physicians or compounding pharmacies for continuing this process. I strongly state the word at this time. I do believe that they are poised to shut down this portion of compounding pharmacies. \
A new issue has arisen. Semaglutide and Tirzepatide have shown themselves to be excellent tools for weight loss. They both are extremely expensive, between 900 and $1000 per month for the diabetic formulation and more than that for the specific weight loss which is known as Wegovy. Clever compounding pharmacies quickly found out if they bought the maximum dose of the medication they could compound it down to a smaller formulation strength to make available to their customers at dramatically lower costs, usually between $300 and $400 per month. Two weeks ago I received a flash notice from the FDA that stated unequivocally that compounded Semaglutide is unsafe. How the medication becomes unsafe when it is withdrawn from one vial and placed into another with a touch of B12 is a mystery to me. The reality is that it is not unsafe, but it is threatening the profits of Big Pharma because they feel like they can sell their product for the $900 plus price tag a month to those same customers.
Unfortunately, what this means is that big Pharma, who directly funds the FDA, has pressured the FDA to make this statement so that they can further erode into the lifespan of their very own grandparents, the compounding pharmacy. They want the compounding pharmacy to go away – big chain pharmacies like CVS and Walgreens have always wanted compounding pharmacies to go away and now they too have these two tools to do so – specifically the legality of any scheduled medications and the FDA trying to ban the use of compounding medications that threaten big Pharma‘s pocketbook. They too are in the process of killing their very own grandparents.
I think it’s sad because I like compounding pharmacies. Compounded medications are a useful tool in medicine and they fill a niche that I utilize not constantly but often – and when you go to a compounding pharmacy, in general, you will be greeted with a smile, you can buy prescriptions and usually a few durable medical equipment pieces, usually a precious moments figurine, and in Texas, occasionally, you can also buy a gun. Hey, it is Texas.
Agree completely. Semaglutide compounding is a Big Pharma nightmare. How dare they sell this medicine at a discount?