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I Make Drugs Not Approved By The FDA | RxRated Podcast · Pharmacy Podcast Network

• 0:05
  Speaker 1: You are listening to the global network of podcasters dedicated
• 0:09
  Speaker 1: to the pharmacy profession. Welcome to the Pharmacy podcast Network.
• 0:24
  Speaker 1: You're listening to Rated RRAs. I want to start you
• 0:31
  Speaker 1: with a question that sounds illegal. Boys. What if your
• 0:35
  Speaker 1: doctor prescribed you a medication that doesn't exist, not insurance
• 0:40
  Speaker 1: denied it not it's on back order, like no company
• 0:45
  Speaker 1: on Earth sells it for millions of people. That's not
• 0:49
  Speaker 1: a thought experiment. That's a Tuesday. And that's where my
• 0:52
  Speaker 1: job comes in. I'm Sam with the Rated RX podcast,
• 0:55
  Speaker 1: affiliate of the Pharmacy Podcast Network, here with Robbie and Xavier,
• 1:00
  Speaker 1: and I'm a compounding pharmacist. Please like and subscribe as
• 1:04
  Speaker 1: you listen to our stories and here, as a compounding pharmacist,
• 1:08
  Speaker 1: illegally make medications from scratch for patients who have run
• 1:12
  Speaker 1: out of standard options. When the healthcare system says, sorry,
• 1:17
  Speaker 1: we did our best, I say, all right, man, let's
• 1:20
  Speaker 1: cook it up a little mortar and pestle. Welcome to
• 1:23
  Speaker 1: my lab.
• 1:25
  Speaker 2: You know, every time you say that, I imagine the DA
• 1:28
  Speaker 2: busting into your private quarter and being like, what are
• 1:31
  Speaker 2: you doing? Sam?
• 1:33
  Speaker 3: Yeah, it sounds like a true com podcast or something.
• 1:37
  Speaker 1: Well, this is why we make this the episode here,
• 1:40
  Speaker 1: I make drugs the FDA hasn't approved. But before we
• 1:44
  Speaker 1: get up in arms and you guys turn me in.
• 1:47
  Speaker 1: Yes it's legal, Yes it's regulated. I am not Walter White,
• 1:51
  Speaker 1: so you know, no need to be worrying about the DEA.
• 1:55
  Speaker 1: Here they come anyways, they still come in and check in.
• 2:02
  Speaker 1: I don't make fake drugs. I make real drugs for
• 2:05
  Speaker 1: real people that pharma forgot about. So today we're pulling
• 2:09
  Speaker 1: back the curtain on compounding pharmacy, what it is, why
• 2:14
  Speaker 1: it exists, and why a lot of patients would not
• 2:17
  Speaker 1: survive without it. So most of us, hopefully you guys,
• 2:21
  Speaker 1: haven't experienced medicine in its easiest form. You go to
• 2:25
  Speaker 1: the pharmacy, you pick up a pill and it works,
• 2:29
  Speaker 1: and you know what, that's a miracle of modern science.
• 2:33
  Speaker 1: But the entire pharmaceutical system is built on the average patient,
• 2:37
  Speaker 1: and it kind of has to be because they're doing
• 2:40
  Speaker 1: mass production of this stuff. And if you're not average,
• 2:43
  Speaker 1: then you're going to fall through the cracks. So let
• 2:47
  Speaker 1: me tell you about two patients. These are examples. We've
• 2:51
  Speaker 1: got some changes and names here, So we have a
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  Speaker 1: Liam and eleanor so. Liam is five years old. He
• 2:59
  Speaker 1: has apple that can be controlled but only with a
• 3:03
  Speaker 1: specific drug, and without it, his life is at risk.
• 3:06
  Speaker 1: So the problem the medication only exists commercially as an.
• 3:10
  Speaker 3: Adult pill man. They really don't give if a crap
• 3:14
  Speaker 3: about little Liam. They don't care about them because it's
• 3:17
  Speaker 3: obviously you know, every five year old loves swallowing a nickel,
• 3:21
  Speaker 3: Sid's peel.
• 3:23
  Speaker 1: Exactly, and it sucks for some kids. They just can't
• 3:28
  Speaker 1: do it. So they there is a liquid. The problem
• 3:30
  Speaker 1: is the strength is two weak. They got one liquid,
• 3:33
  Speaker 1: one strength, and in this case, it also has red
• 3:36
  Speaker 1: dye number forty, which Liam is severely allergic to. So
• 3:41
  Speaker 1: his parents are offered three choices. A dose that doesn't work,
• 3:47
  Speaker 1: a medication that causes an allergic reaction, or a pill
• 3:51
  Speaker 1: he physically can't take. Size of these nickels Xavier's talking about.
• 3:56
  Speaker 1: And that's it.
• 3:58
  Speaker 2: That is not much of a choice at all. I
• 4:01
  Speaker 2: can't imagine being a parent like that and be put
• 4:04
  Speaker 2: in that situation, and I don't know, I personally feel
• 4:07
  Speaker 2: very helpless, especially because I feel like my son's child's
• 4:12
  Speaker 2: health would be at risk, and basically taking hostage.
• 4:16
  Speaker 1: That's right, and the drug exists. So it's sitting out there.
• 4:19
  Speaker 1: You're taking your son in and you can see it
• 4:22
  Speaker 1: sitting there behind the counter, but it's just not going
• 4:24
  Speaker 1: to work, not going to work for him. And now
• 4:26
  Speaker 1: we look at Eleanor. She's eighty two, congestive heart failure,
• 4:31
  Speaker 1: absolute legend of a human. But she's on seven medications,
• 4:36
  Speaker 1: which you know, at her age can start to be
• 4:38
  Speaker 1: more popular, some with food, some without, some in the morning,
• 4:43
  Speaker 1: some at nights. Arthritis making it hard to open bottles.
• 4:47
  Speaker 1: That dang pharmacist forgot to put the easy open on
• 4:50
  Speaker 1: this one bottle, and she's struggling. And you know, a
• 4:54
  Speaker 1: little exaggeration, but you know when miss pill could be
• 4:57
  Speaker 1: putting her back in the hospital or could be causing
• 4:59
  Speaker 1: problems starting to take six instead of seven. Forgets one
• 5:02
  Speaker 1: of those bottles and we're having we're having problems there,
• 5:06
  Speaker 1: those problems right there.
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  Speaker 3: Yeah, man, Like, medication adherence is already difficult enough, let
• 5:14
  Speaker 3: it alone, having six, seven different pills, some of them
• 5:17
  Speaker 3: two and three times a day. I mean, you can
• 5:19
  Speaker 3: be young and healthy and have trouble with these. So
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  Speaker 3: I know, this maybe a lot for her.
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  Speaker 1: And again the drugs exist to help her system, to
• 5:27
  Speaker 1: help what she's looking for, but it's just doesn't work
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  Speaker 1: for her, and we're going to cause problems. Some people
• 5:33
  Speaker 1: can do it, no, maybe even us could struggle, even
• 5:37
  Speaker 1: at our spry, young thirties here, but the system is
• 5:42
  Speaker 1: going to fail a number of people. And these cases
• 5:45
  Speaker 1: aren't rare. You have again, we were talking kids, infants,
• 5:49
  Speaker 1: even more so, any tablet cancer patients, feeding tubes. Most
• 5:54
  Speaker 1: common one that I see compounding is medications in oil
• 5:58
  Speaker 1: for feeding tubes, and they pretty much we'll just completely
• 6:01
  Speaker 1: clog up, and it's such a hassle of trying to
• 6:04
  Speaker 1: get through the right person understanding it's like, hey, this
• 6:07
  Speaker 1: med won't go through here. We just can't do it.
• 6:09
  Speaker 1: And finally you get someone's like, oh yeah, they know
• 6:11
  Speaker 1: it's obvious, and we get things changed. But you can
• 6:14
  Speaker 1: go through a number of people just to get a
• 6:17
  Speaker 1: med to go through a feeding tube. Then we got allergies,
• 6:21
  Speaker 1: rare diseases. The doctor's done the legwork, they got the diagnosis,
• 6:26
  Speaker 1: they have the prescription, they got the med that can
• 6:28
  Speaker 1: help them. It's just an unusable medication. And that's where
• 6:33
  Speaker 1: compounding lives. The problem isn't that the drug doesn't exist.
• 6:38
  Speaker 1: It's that the patient doesn't fit the box that it
• 6:41
  Speaker 1: comes in. So what do we actually do. I'm a
• 6:43
  Speaker 1: compounding pharmacist, which basically means I live in the healthcare
• 6:46
  Speaker 1: gray zone, but a very regulated one. Historically, all pharmacists
• 6:52
  Speaker 1: compounded mortar and pestle raw ingredients custom meds, and then
• 6:56
  Speaker 1: mass manufacturing came later.
• 6:58
  Speaker 2: So you're like, you're basically an old school apothecary, kind
• 7:02
  Speaker 2: of like those guys way back in the day going
• 7:05
  Speaker 2: door to door having a little bag of the random tinctures.
• 7:08
  Speaker 2: Hopefully not selling snake oil in this case.
• 7:11
  Speaker 1: Right, old school baby, definitely better ppe than those door
• 7:16
  Speaker 1: to door salesmen. But no, no snake oil. No snake
• 7:19
  Speaker 1: oil here, not allowed by USP not yet anyway, it's
• 7:23
  Speaker 1: not a USP med and.
• 7:25
  Speaker 2: We can purchase's. That's good because that doesn't work like
• 7:29
  Speaker 2: many supplements easy.
• 7:32
  Speaker 1: Now, thanks for later. So we are traditionally trying to
• 7:38
  Speaker 1: help a patient individually, and then big pharma shows up,
• 7:41
  Speaker 1: and you know what, if we made one pill for everyone,
• 7:43
  Speaker 1: and it's kind of the name of the game. They
• 7:45
  Speaker 1: got to do it that way. There's so many people,
• 7:47
  Speaker 1: so many pills. That's the only real feasible way to
• 7:49
  Speaker 1: do it. And again, it just can make it tough
• 7:52
  Speaker 1: for people. And that works great until it doesn't. I
• 7:54
  Speaker 1: guess right, that's right. So think of these mass produced
• 8:01
  Speaker 1: drugs like off the rack suits they fit most people
• 8:04
  Speaker 1: kind of. I remember Xavier's sued at his wedding. You
• 8:07
  Speaker 1: know that was that was prime, that was bespoke, And
• 8:10
  Speaker 1: that's that's compounding right there, made just for him. So
• 8:14
  Speaker 1: we can change doses, we can turn pills into liquid,
• 8:18
  Speaker 1: remove dies, fillers, preservatives, combine meds, create forms that don't
• 8:23
  Speaker 1: exist commercially. So let's get to that scary headline that
• 8:29
  Speaker 1: everyone probably have heard. The final compounds or any compound
• 8:34
  Speaker 1: that we make is not FDA approved.
• 8:37
  Speaker 3: Oh snap, TikTok dance, everybody grow.
• 8:39
  Speaker 1: Crazy, everyone, everyone hates it. And that's what they see.
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  Speaker 1: I know, when we're compounding with clinics or clinics call in,
• 8:46
  Speaker 1: that's one thing that they always bring is, oh yeah,
• 8:48
  Speaker 1: well the commercial product that has this, They told us
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  Speaker 1: that you aren't FDA approved or FDA regulated. That's not
• 8:56
  Speaker 1: an FDA product. And you know, I just you got
• 8:59
  Speaker 1: to explain to him. It's like that statement is one
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  Speaker 1: hundred percent true. As soon as we take a single
• 9:04
  Speaker 1: tablet and crush it, move change a single thing, it
• 9:08
  Speaker 1: is now considered an adultered product. And yeah, it's a
• 9:11
  Speaker 1: scary word. It's a scary thing to blanket everything in,
• 9:14
  Speaker 1: but that's literally what it means. And once you explain
• 9:17
  Speaker 1: it to the clinics, it makes a lot more sense
• 9:19
  Speaker 1: to them because they do use us for other compounds,
• 9:21
  Speaker 1: so they're familiar with a cream or something else, and
• 9:24
  Speaker 1: it starts getting more and more complicated and they're concerned.
• 9:27
  Speaker 1: But it's like, oh, yeah, yeah, as soon as you
• 9:29
  Speaker 1: make this cream for my patient, that makes sense that
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  Speaker 1: it's not FDA approved because it didn't go through these
• 9:34
  Speaker 1: clinical trials and it kind of eases up for them
• 9:39
  Speaker 1: on that. But that's the case that you got to
• 9:41
  Speaker 1: do to help the one patient. So instead of those
• 9:44
  Speaker 1: clinical trials, you know, the process is regulated. There are
• 9:49
  Speaker 1: FDA registered ingredients, suppliers, state Board oversight, USP, safety and
• 9:54
  Speaker 1: sterility standards, clinical justifications required from providers. I can't just
• 10:00
  Speaker 1: go vibe in my way and to inventing drugs.
• 10:04
  Speaker 2: That's good because we don't want your secret sauce in there.
• 10:08
  Speaker 1: Sam, huh No, not so not regulated there the medication
• 10:12
  Speaker 1: is an FDA approved but the ingredients, the pharmacy and
• 10:16
  Speaker 1: the process absolutely are so a little bit into kind
• 10:20
  Speaker 1: of the pharmacy and a little piece behind the curtain there.
• 10:23
  Speaker 1: Day doesn't necessarily start with mixing and actually in the
• 10:25
  Speaker 1: compounding part. For our pharmacy, a lot of technicians are
• 10:28
  Speaker 1: the ones actually doing the compounding. So for us it
• 10:31
  Speaker 1: can start with problem solving a little bit more than
• 10:34
  Speaker 1: maybe people are used to hearing about or seeing about.
• 10:37
  Speaker 1: So if we go back to Liam's example, the neurologist
• 10:41
  Speaker 1: sends us a script essentially saying unable to swallow pills
• 10:44
  Speaker 1: allergic to red dye number forty, please compound die free liquid.
• 10:51
  Speaker 1: So that can be kind of the basis that we
• 10:53
  Speaker 1: start off. And some patients, especially for electronically prescribed, by
• 10:59
  Speaker 1: the way doctors can send scripts in they have kind
• 11:02
  Speaker 1: of drop down menus they can do, so they can't
• 11:05
  Speaker 1: select what they want in some cases. For us, normally
• 11:08
  Speaker 1: it's just we want one of these tabs and one
• 11:11
  Speaker 1: of these four strengths, and they can just click a
• 11:13
  Speaker 1: button and send it off. For us, usually they can't
• 11:17
  Speaker 1: actually select what they want, so they got to write
• 11:19
  Speaker 1: it out freehand like this, We've got to have some
• 11:22
  Speaker 1: calls back and forth. So it can start with some
• 11:24
  Speaker 1: math calculating, usually always off weight age, safety margins, what
• 11:28
  Speaker 1: sort of dose we're kind of looking for, what we
• 11:31
  Speaker 1: can even get a hold of, And then it's formulation science.
• 11:36
  Speaker 1: So will they dissolve? What kind of base do we
• 11:39
  Speaker 1: have to do? How stable? How long can it be stable?
• 11:42
  Speaker 1: We want this kid on this long term? Well, we
• 11:45
  Speaker 1: can only make something that lasts for five days, ten days.
• 11:48
  Speaker 1: That's also not going to be a very effective drug
• 11:51
  Speaker 1: for Liam, And then for kids itself. Is it going
• 11:54
  Speaker 1: to taste bad? Are they Are we going to find
• 11:57
  Speaker 1: some flavor? Is it going to be a weird texture? Again?
• 12:00
  Speaker 1: Are we even gonna be able to get that patient?
• 12:02
  Speaker 1: And we are gonna get Liam a kid to take this?
• 12:04
  Speaker 2: Men, Yeah, you gotta make sure it tastes good or
• 12:06
  Speaker 2: they're gonna spit it out.
• 12:07
  Speaker 3: Man.
• 12:08
  Speaker 2: I hear kids like that bubble gum flavor.
• 12:11
  Speaker 1: Usually usually they do like the bubble gum. It is
• 12:13
  Speaker 1: a good choice. And so before we can proceed or
• 12:17
  Speaker 1: make things from there, we got to call the clinic,
• 12:19
  Speaker 1: We got to call the doctor. We kind of walk
• 12:21
  Speaker 1: through it kind of talk as a team because they also,
• 12:26
  Speaker 1: you know, don't know what we can make and what
• 12:28
  Speaker 1: the options are. They got an idea on there end
• 12:29
  Speaker 1: as well what they think can help Liam, and we're
• 12:32
  Speaker 1: trying to find something in the middle there. So now
• 12:36
  Speaker 1: to Eleanor, we are back to those multiple meds. We
• 12:40
  Speaker 1: got seven here that she's taken, and we're looking to
• 12:43
  Speaker 1: put this into one capsule. And you know, on the surface,
• 12:47
  Speaker 1: that seems easy, but you start looking at chemistry and
• 12:50
  Speaker 1: of course it says absolutely not. Turns out only six
• 12:53
  Speaker 1: of them can go together, and one isn't gonna play
• 12:57
  Speaker 1: well with friends. So we've got at least six of
• 13:00
  Speaker 1: these we can combine. So we got to call the
• 13:02
  Speaker 1: cardiologists and be you know, hey, what if we can
• 13:05
  Speaker 1: make one capsule with six meds and a tiny capsule
• 13:09
  Speaker 1: for the last one. So now seven pills become two.
• 13:13
  Speaker 2: Whoa, that's kind of wild.
• 13:15
  Speaker 3: Just put everything all in one little pill. I mean,
• 13:18
  Speaker 3: that'll definitely help with it here. It's for sure.
• 13:21
  Speaker 1: Indeed, medication doesn't work if the patient can't realistically take it.
• 13:26
  Speaker 1: We had one of our professors who also went to MD.
• 13:30
  Speaker 1: I remember working with them in school at Creighton but
• 13:33
  Speaker 1: talking a little bit about the story of like why
• 13:35
  Speaker 1: you want to do this and different things, but a
• 13:37
  Speaker 1: piece of wanting to know both sides and MD wanting
• 13:40
  Speaker 1: to know pharmacy side, and it's like, I can prescribe
• 13:43
  Speaker 1: anything and everything. I want to make this patient better.
• 13:46
  Speaker 1: It really doesn't matter if they won't ever take the
• 13:48
  Speaker 1: med or they're taking it wrong, or we can't get
• 13:52
  Speaker 1: that communication to them, that isn't going to help my patient.
• 13:56
  Speaker 1: And so there was that kind of level of respect
• 13:59
  Speaker 1: or that last pie of understanding that you know, how
• 14:03
  Speaker 1: they take it, if they can take it, when they
• 14:05
  Speaker 1: take it is important for them to be able to
• 14:08
  Speaker 1: get better on whatever it might be we're trying to prescribe.
• 14:11
  Speaker 1: So now the lab it's not chaotic, not dramatic again,
• 14:17
  Speaker 1: no Walter White out there, rather boring in the best way.
• 14:21
  Speaker 1: Ultra precise balances, capsule machines, ointment mills, and yes, of
• 14:27
  Speaker 1: course mortar and pestles. We got plenty of them, glass, ceramic, small, medium, large,
• 14:33
  Speaker 1: anything and everything to mix those meds. So for LIAM medication,
• 14:38
  Speaker 1: the precision matters. We weigh active ingredients, logging a lot numbers,
• 14:43
  Speaker 1: expiration dating, geometric dilution, Robbie and I had to do
• 14:47
  Speaker 1: this in a class we went down to in Texas
• 14:50
  Speaker 1: for some compounding training where they had us do geometric
• 14:53
  Speaker 1: dilutions and making sure we can mix meds correctly and
• 14:57
  Speaker 1: mixing every single little mill leader just to maan sure
• 15:00
  Speaker 1: that every dose is exact for Liam, last adding that
• 15:06
  Speaker 1: flavor sugar free, die free bottle label and now Liam
• 15:12
  Speaker 1: has his med that can literally save his life.
• 15:15
  Speaker 3: Yeah.
• 15:15
  Speaker 2: I mean it's not flashy and people don't see it
• 15:19
  Speaker 2: and may not be sexy, but it's life changing for sure,
• 15:23
  Speaker 2: especially for Liam.
• 15:24
  Speaker 1: And now to Eleanor's capsules six powders mixed carefully again
• 15:28
  Speaker 1: that geometric dilution loading capsules seven become two. That's not convenience,
• 15:36
  Speaker 1: that's independence. Sometimes the most powerful thing you can give
• 15:40
  Speaker 1: a patient isn't a new drug, it's fewer bottles. Everything
• 15:44
  Speaker 1: we've talked about so far as non sterile. So now
• 15:47
  Speaker 1: we move into sterile compounding, whole different universe. And that's
• 15:51
  Speaker 1: my wheelhouse that I do. Run a sterile department, so
• 15:54
  Speaker 1: a lot of steril meds that I have to deal with,
• 15:57
  Speaker 1: getting those injectable's eye drops going. We've got clean rooms hebafilters. Again,
• 16:04
  Speaker 1: excessive ppe gowning procedures make it looks like airport security
• 16:10
  Speaker 1: is just walk in the park, hair covers, mass shoe covers,
• 16:15
  Speaker 1: hand washing rituals, sterile gowns, sterile gloves. And then for
• 16:20
  Speaker 1: our compounding, it's a considered high risk where we're using
• 16:24
  Speaker 1: raw ingredients or non sterile powders. So in our case,
• 16:27
  Speaker 1: pretty much everything that comes into there besides the powder
• 16:31
  Speaker 1: has to be sterile, so we have to sterilize all
• 16:34
  Speaker 1: our hairnets, masks, shoe covers, everything trend to limit any
• 16:39
  Speaker 1: risk of going in there for our sterile room. And
• 16:43
  Speaker 1: so this little example here today we're preparing a chemo
• 16:46
  Speaker 1: infusion for my not home patient negative pressure room, hazardous
• 16:51
  Speaker 1: drug lamin ar flow hood. Trying to protect the tech
• 16:54
  Speaker 1: that's compounding this, extra double gloves, chemo rated, all sorts
• 16:59
  Speaker 1: of extra precautions there, every vile wiped down with sterile alcohol,
• 17:04
  Speaker 1: every movement deliberates and then mixed and inspected for that safety.
• 17:10
  Speaker 1: This is invisible medicine, but without it, at home infusions
• 17:13
  Speaker 1: don't exist.
• 17:15
  Speaker 3: Yeah, pig and backing off, you know, with Sam said,
• 17:17
  Speaker 3: we do the same thing. Impatient oscole to the same
• 17:20
  Speaker 3: process sterol compounding process. So all those things he's talking
• 17:23
  Speaker 3: about galloning up, make sure everything's sterile, using specific techniques
• 17:28
  Speaker 3: to make sure there's no bacteria or anything introduced into
• 17:32
  Speaker 3: the medication. This is hardcore science and this is where
• 17:36
  Speaker 3: you put our trust in us, and this is lay
• 17:37
  Speaker 3: it is very regulated to make sure the compounding is
• 17:40
  Speaker 3: done correctly and safely.
• 17:42
  Speaker 1: Yes, indeed, in sterile compounding, one mistake is in an oops.
• 17:46
  Speaker 1: It can be a catastrophe and nothing leaves without a
• 17:50
  Speaker 1: second pharmacist checking everything. So it's either being done ahead
• 17:54
  Speaker 1: or a text doing it. And then again it gets
• 17:56
  Speaker 1: checked again, both with US and I know same with
• 18:00
  Speaker 1: hospital with day where it's everything gets looked at again,
• 18:04
  Speaker 1: math gets rechecked, ingredients rechecked, lot numbers, final product, and
• 18:09
  Speaker 1: then the label beyond youse dating not an expiration date, shorter, honest,
• 18:16
  Speaker 1: more concerned with risk with patients because these are being
• 18:21
  Speaker 1: compounded there and that's where that regulation part comes in.
• 18:25
  Speaker 1: And then for me, part of that favorite part is
• 18:28
  Speaker 1: the counseling, either before or after, but being able to
• 18:32
  Speaker 1: explain to Liam's parents that we do have a solution
• 18:35
  Speaker 1: to help them. Watching eleanor realize that she only has
• 18:38
  Speaker 1: two capsules now and that freedom of remembering the meds
• 18:43
  Speaker 1: and that moment, that's the job, that's the payoff.
• 18:47
  Speaker 2: Bravo, sir, bravo. I mean, that's that's the moment you
• 18:51
  Speaker 2: pat yourself on the back and the vision you wake
• 18:53
  Speaker 2: up in the morning after all right.
• 18:55
  Speaker 1: Indeed, sometimes it's hard, but you know, still still getting up,
• 18:58
  Speaker 1: not getting that super early. I think, Robbie, you do
• 19:01
  Speaker 1: get up pretty early. I do, so got that early
• 19:05
  Speaker 1: bedtime getting old. But a compounding is that ancient art
• 19:10
  Speaker 1: that's meeting modern science. So we're not replacing big pharma
• 19:13
  Speaker 1: where we're filling the gaps. We make the drugs that
• 19:16
  Speaker 1: don't exist, so patient can have lives that do. Sometimes
• 19:22
  Speaker 1: the best medicine isn't invented yet, it's just hasn't been compounded.
• 19:26
  Speaker 1: And if you've ever been told sorry, there's no options left,
• 19:30
  Speaker 1: ask about compounding, because sometimes the medicine you need doesn't
• 19:34
  Speaker 1: exist until someone can make it legally, allegedly, always legally, boys,
• 19:41
  Speaker 1: always legally. So remember, you know we can do those
• 19:44
  Speaker 1: helpful things, not just me as a compounding pharmacist, but
• 19:48
  Speaker 1: these other pharmacists. You know they can also be able
• 19:51
  Speaker 1: to think outside the box, get things that you might
• 19:53
  Speaker 1: normally be able to get, and they want to help you.
• 19:56
  Speaker 1: But in our case for compounding custom dosing those allergies,
• 20:00
  Speaker 1: changes in forms, capsules, liquids, feeding tubes, custom combos. You know,
• 20:06
  Speaker 1: it doesn't hurt to ask. People call all the time
• 20:08
  Speaker 1: asking if there's something that we can do for him,
• 20:11
  Speaker 1: and a lot of time we are able to help
• 20:13
  Speaker 1: or at least have more knowledge than a retail pharmacy
• 20:17
  Speaker 1: that maybe hasn't even seen a med or a certain
• 20:20
  Speaker 1: form that we're able to work with. So thank you
• 20:23
  Speaker 1: all for listening. This is the Rated RX podcast. If
• 20:26
  Speaker 1: this episode talk to you something new, please share it,
• 20:29
  Speaker 1: like and subscribe. I'm Sam with Xavier and Robbie. All right,
• 20:34
  Speaker 1: peace out. Rated our rection times for the day