Innovators: Compound interest

When the National Association of Pharmacy Regulatory Authorities (NAPRA) announced new mandatory model standards for pharmacy compounding of non-sterile preparations across Canada, pharmacies had only one to two years to complete the upgrades and training needed to meet new guidelines—or cease their compounding services altogether.In Alberta, Create Compounding Pharmacy was already operating a successful retail and compounding pharmacy, and became among the first in the province to adapt NAPRA’s new standards. In fact, demand for compounding services increased so significantly after the guidelines were introduced in 2019, pharmacist/owner Andrew Costello opened an accompanying 10,000 square-foot-lab in 2021 focused solely on compounding to help service the pharmacies and patients who required compounded medications.As the guidelines were being rolled out in other parts of Canada, Costello saw the opportunity to expand his business further by providing central-fill compounding services in other provinces too.“I was working at an independent community pharmacy in Ontario when Andrew called to ask me to run the Ontario pharmacy as NAPRA standards were coming here,” says co-owner Tyson Smith, who first met Costello while at pharmacy school in Brisbane, Australia. (The company’s other co-owners were also pharmacy classmates in Brisbane.)The idea proved fruitful. Create Compounding Pharmacy is now a team of 100+ offering central-fill compounding services in Alberta, Ontario, B.C. and New Brunswick. It counts independents and big corporate chains among its clients, as well as clinics, hospitals, individual doctors and patients. There is even high demand for compounding services by veterinarians and pet owners.“There has been a large uptake in services in all our four locations, especially in this climate where there is a huge need for compounding services,” says Smith, noting an increasing demand for specialized formulations and alternatives for drug shortages. “We are always sending notes to our pharmacy partners saying we’ve got solutions when medications are on backorder, and filling those gaps is a really rewarding experience—I think this model is here to stay.”In fact, all Create Compounding locations have at least doubled the size of their facilities since opening. In fact, the B.C. facility has expanded from 4,500 square feet to 12,000 square feet, thanks in part to significant demand there for veterinary compounding. Smith says the company has staff members dedicated to marketing and sales for each client group. “Most of this is done by phoning the pharmacies/vet clinics directly and explaining our service offerings,” says Smith. “It’s a full, hands-on approach to develop a rapport with the client and build a trusting partnership.”He says the company has robust instructional video/manuals to onboard new clients for central-fill compounding which include how to build the drug/mixture files and enter the pseudoDIN to bill directly for their patients. They take the orders at their pharmacies and Create Compounding takes care of the rest. “We’ve even developed an online marketplace with some 6,000 formulas for our pharmacy partners so they can log into our portal, order their medications and get quotes in real-time to share with their patients,” says Smith, adding that this portal is available in all four provinces.The pharmacy ships compounded medications to its pharmacy clients, who will then relabel it with their pharmacy label and coordinate with the patient directly for pickup or delivery. For walk-in patients with prescriptions, Create will ship directly to them. (Medications are generally shipped out by the next business day.) “We want to be a partner to the pharmacy and help them expand this compounding service offering locally,” says Smith. “[This] will hopefully allow them to develop relationships with their local providers and grow their patient population.”Smith says Create’s services also offer local doctors “new tools in their toolbox” and a more personalized approach to medication. For example, a patient with osteoarthritis with kidney disease who can’t use oral NSAIDs can get a personalized pain cream formulated to address the pain in the local areas of application, without risking systemic absorption affecting their kidney health. Using the service can also provide access to care for patients who don’t have a compounding option in their area or in the time frame they need it filled.The types of medications being compounded vary every day at each location and between provinces. “We get a lot of pediatric suspensions for things that need to be made from capsule or tablet to liquid form and there are a lot of topical pain creams,” says Smith. “We also have more specialty market items like bioidentical hormones emerging as there are more companies specializing in providing unique care and a lot of what prescribers are prescribing isn’t commercially available.”While Smith sometimes misses the patient interaction being in a lab setting with only the occasional walk-in patient, his team in Mississauga, ON, has grown from four to 25 in two years, including four staff pharmacists. “We also have a huge need for technicians in the compounding industry as they have a scope of practice that allows them to do sterile compounding and technical verifications,” he says. “We like to focus on bringing in great technicians who can work to their whole scope of practice, and we have registered a few techs as preceptors at the local colleges too.”With 200-250 prescriptions coming into the Mississauga location daily, work life certainly isn’t boring, says Smith. “If I’m not interacting with patients or healthcare providers, I’m building formulations, referencing the NAPRA guidelines and working within regulations,” he says. “I never know what’s going to come through the door and I love the variety of prescriptions and the fact we’re fixing a need in the healthcare system.”Still, starting a central-fill compounding pharmacy in Ontario from scratch certainly had its challenges, admits Smith. “I didn’t anticipate a large difference between provinces in implementing the central-fill pharmacy, but Alberta is used to this model and here it was a novel idea,” he says.Despite “endless training and time” spent getting licensing for the pharmacy, Smith says he soon realized the pharmacy regulators were ultimately there to help and not hinder the process. “We want to be the best compounding pharmacy in the country and that means always being open and transparent,” he says.As for future expansion plans, there are certainly other provinces for Create Compounding to venture into if the demand is there, say the owners. “Ultimately we want pharmacies to look at us as a true partner or extension of their pharmacy, filling these gaps in care that do arise, believe it or not, every single day,” says Smith.

Innovators: Compound interest

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