Compounding Pharmacies: A Viable Option, or Merely a Liability?

Abstract

You have recently been appointed to be the medical director of an ambulatory surgical center. This center focuses on interventional spine procedures and is used by several independent physician practices in the community. The manager of the center approaches you regarding medication options at the center. Several physicians in the group are requesting that she reorder preservative-free betamethasone phosphate from a compounding pharmacy. They believe strongly that this corticosteroid formulation has the distinct advantage of containing neither particulates nor preservative but is not available from a commercial pharmacy. In contrast, the commercially available form of betamethasone (Celestone Soluspan [Schering Corp, Kenilworth, NJ]), both contains a preservative and is a particulate corticosteroid due to the inclusion of betamethasone acetate in its formulation. The manager of the center is aware of the recent meningitis outbreak and is concerned that allowing any medications from compounding pharmacies is an unacceptable risk to patients. She also believes that using a compounding pharmacy in this setting may be a medicolegal liability to the surgical center. David O’Brien, MD, will argue that physicians should have the ability to use compounding pharmacies and Isaac Cohen, MD, will argue that compounding pharmacies should not be used. Please note the views expressed in this article are for educational purposes only and do not constitute a personal endorsement or necessarily reflect the current practice patterns of the discussants. They also are not intended to establish the standard of care.