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What are dermatologists saying about this topical treatment for skin cancer?

BACKGROUND

Actinic keratosis (AK) is a precursor to a type of skin cancer called squamous cell carcinoma. Long treatment durations and/or severe side effects can possibly interfere with the efficacy of current actinic keratosis treatments. Sometimes, these experiences can prevent prescribers from using the standard treatment of Effudex (fluorouracil) during the summer. Physicians are finding compounded 5-fluorouracil and calcipotriene to be an effective topical treatment for several reasons including reduced treatment time.

STUDY CONCLUSION

In November of 2016, a study was released that stated the combination of two manufactured topical drugs that have been in use for years triggers a robust immune response against precancerous skin lesions. By combining Effudex (5-fluorouracil) and (Dovonex) calcipotriene, the treatment time is reduced to 4 days and found there was an 86% reduction in the number of facial AKs, compared with a 26% reduction among patients who used 5-FU monotherapy in a Vaseline petroleum jelly (P less than .0001). The study also found that after four days of an effective treatment, there was no crusting, pain or ulceration. The research article can be entirely read here: https://www.jci.org/articles/view/89820

OTHER COVERAGE

News outlets have also covered and written articles on the study. The research, from Washington University School of Medicine in St. Louis and Harvard Medical School, shows that the therapy activates the immune system’s T cells, which then attack the abnormal skin cells. Siteman Cancer Center released an article on this topic and it can be found here: New Topical Immunotherapy effective against early skin cancer. Additionally, an article by Amy Karon on June 9, 2016 that appeared in the MD Edge Internal Medicine covered the results of the study. If you would like to read this article in its entirety, you will find it here: https://www.mdedge.com/internalmedicine/article/109517/actinic-keratosis/adding-calcipotriene-5-fu-dramatically-reduced-aks

BENEFIT-Patients Don't have to mix at home, which could cause ineffective ratio.

With a shortened treatment time, dermatologists are choosing to prescribe the combination treatment for convenience, not delaying treatment with the standard medication and this can increase compliance. Some patients will be prescribed a medication and not get it filled at the pharmacy or may lose their prescription. Getting the combination compounded and filled as soon as possible can help the patient. “Four days is a lot less time than 2-3 weeks and I can see using this for some of my active patients this summer” said a dermatologist from northern Alabama that is currently using the combination treatment.

Patients prefer the 4-5 day treatment instead of 3 weeks. I have been able to prescribe this compounded medication this summer. -- Dermatologist from northern Alabama that is currently using the combination treatment.

When sending a patient to a retail pharmacy to take home two separate medications, you are sometimes creating an issue for your support staff


PROBLEM: Patients are required to mix at home if using two different medications from a regular retail pharmacy.

Nurses and medical assistants for dermatologists that are using this therapy have all experienced the same problems when giving a patient two different manufactured prescriptions to get filled and mix at home. This is problematic due to accuracy of ratio and there are no thorough mixing safeguards like a compounding pharmacy offers. Inevitably, many of the patients, including the older population, are very nervous about having to mix these two medications at home. One nurse for a dermatologist said that “mixing the medications at home can cause anxiety and we do have to reeducate the patient on mixing. We already have to attend to all of the other calls so using a compound pharmacy alleviates some of these unnecessary calls.”

BENEFIT of using Compound Pharmaceutical Technologies
Using a well-established and reputable compounding pharmacy can ensure that your patient is getting the accurate dosing and ratio that takes the anxiety away from the patients and providers. If you use a compounding pharmacy, make sure you ask them if their scales are connected to a computer pharmacy-based software. John Hart from Compound Pharmaceutical Technologies Inc. in Daphne, Al uses a scale connected to computer software as an extra layer of safety and assurance for all parties involved, including the pharmacy. John Hart stated, “when explaining to patients and providers that we have gone the extra mile when compounding our medications, they appreciate our posture towards their patient’s health and the accuracy of what we compound.”

PROBLEM: Traditional pharmacy may be out of stock
Sometimes, retail pharmacies may run out of stock because keeping a minimal amount of stock on their pharmacy shelves means lower overall inventory. During the busy season for treating AK, they may not keep adequate stock of a medication, especially calcipotriene as most retail pharmacies aren’t familiar with this study. If a retail pharmacy has 10 patients that walk in that need a specific mediation like calcipotriene and the pharmacy only stocks 5, then half of those will have to come back on another day or travel to other pharmacies until they find one that is in stock.

BENEFIT of using Compound Pharmaceutical Technologies
Although compounding pharmacies must deal with inventory as well, how ingredients or chemicals are purchased is quite different. A compounding pharmacy will order a 500gm container of the active fluorouracil ingredient from an FDA approved facility which happens to sometimes be the same facility that pharmaceutical manufactures use. However, that one 500gm container could be used to fill over 200 patients. Some compounding pharmacies use an automated inventory indicator system that informs the lab when chemicals are getting low and need to be reordered. The system is typically set to alert when the chemical quantity is low, but still adequate to fill multiple patients. This inventory control allows for the new order to arrive in enough time so that inventory never runs out.

PROBLEM: Too Costly or Not Covered
Often, insurance companies will have deductibles, high copays or just simply won’t cover some of the medications. Having two different medications could be costly to the patient. If a patient must pay for both medications out of pocket, the generic cost for both could be as high as $400.00. Often compounding pharmacies can compound medications for under a tier three copay level.

BENEFIT of using Compound Pharmaceutical Technologies
Without having to answer to corporate headquarters or shareholders, each independent compounding pharmacy has more control over the cost to the patient. John Hart from Compound Pharmaceutical Technologies states that "a pharmacy cannot compound anything that is commercially available or for the sole purpose of costs. However, these two combined medications are not offered by any pharmaceutical manufacturer. With many of our compounds, we can keep them at an affordable rate. This is far better than what patients can find at their traditional retail pharmacy for non-covered medications.”

PROBLEM: Wasted money (One size does not fit all)
While the surface areas of treating AK’s can vary, sometimes smaller or larger quantities are needed. Typically, fluorouracil only comes in 45g. Sometimes this is too much and sometimes not enough. This can cause the patient to overpay or must buy another tube to complete therapy. Often smaller quantities are needed for the treatment duration for facial application and larger quantities are needed for chest, arms and legs. [JH2]

BENEFIT of using Compound Pharmaceutical Technologies
Since compounding pharmacies offer options for dermatology practitioners to prescribe different combined options of medications, they can also prescribe different quantities. Commonly prescribed quantities for this therapy are 15g, 30g and 60g.

Closing / Summary

Using this compound therapy will help with the following:

  • Patients don't have to mix at home
  • Prevents support staff from unnecessary phone calls
  • Shorten treatment time as referenced in the study
  • Increase compliance
  • No insurance hurdles
  • Affordable option
  • Payment plan if necessary
  • Accountability - We will send a patient note if not filled.

At Compound Pharmaceutical Technologies, we take the guesswork out of it for your patients and the worry out of it for you and your medical staff. Call to action???

John Hart, Compound Pharmaceutical Technologies

Referral Process

STEPS FOR ORDERING COMPOUNDED MEDICATION WITH ORDER SHEET

  1. Check medication: include patient information, date of birth, the best contact cell number and email address.
  2. Check providers instructions if applicable:
  3. E-scribe or fax the prescription to: 1-866-684-MEDS (6337). If available, including a Demographic sheet may help expedite the prescription.
  4. Hand the patient an information card: We have provided your office with a patient card that has our contact information.
  5. Please feel free to contact our pharmacy if you have any questions: Contact us at 1-866-591-6337.

E-Prescribing Information: SOME E-PRESCRIBING SOFTWARE CAN SEND COMPOUNDS. CALL US FOR INFORMATION OR CALL YOUR SOFTWARE TECH SUPPORT.

  • Search Name: Compound Pharm Tech, CPT Inc.
  • Search City/State Name: Daphne, AL
  • Search NCPDP#: 0134445