Frequently Asked Questions

Compounding is the art – and science – of preparing medications that are personalized to a specific patient. Sometimes a patient cannot tolerate a commercial medication, or that medication is only available in dosages that are too high or too low for a patient’s needs. When that’s the case, a doctor will write out a custom order, and the pharmacy will prepare the prescription. For instance, if a patient is allergic to the dyes or “glue” in commercial thyroid medication, we can make natural thyroid capsules. We can make a medication commonly used to lower blood sugar into a topical cream that can help patients avoid uncomfortable side effects. We can also put multiple hormones into a lozenge so the medication dosage can be administered once daily…as opposed to the patient needing to take multiple medications throughout the day.

Specialty medications – or specialty drugs – refer to complex medications considered to be high cost, high touch, and specific to certain diseases. They are not the typically prescribed, commercially available cholesterol, diabetic, blood pressure, or mood stabilizing medications. Some of the specialty medications on the market today are used to cure hepatitis C, treat HIV/AIDS, relieve rheumatoid arthritis pain, and help grow and nurture eggs for fertility treatment. These medications come in a multitude of forms, including tablets, oral solutions, injectable treatments, and under the tongue sprays, just to name a few. Specialty drugs are likely to be prescribed by doctors who are specialists in their field.

Specialty medications are hard to get because often the pharmacy has to have a contract with the manufacturer of the drug in order to dispense it – or just be able to offer it at an affordable price for the patient. Additionally, most insurance companies will only cover these medications with what is called a prior authorization.

In essence, a prior authorization (PA) is an explanation by the doctor’s office to your insurance company as to why you need to take a specific, expensive medication, typically not covered by standard insurance policies. Insurance companies want to verify the medical necessity of a certain drug before they decide to pay for it. Specialty medications require comprehensive explanations, which may include metabolic labs, imaging, and past medication history. The PA requests are reviewed by doctors and pharmacists at the insurance company, who assess the information and, using a rubric, make a decision whether or not to cover that specific medication.

Most pharmacies will usually only inform the doctor’s office when a prior authorization is needed for a medication. AVRIO Pharmacy goes well beyond that basic step, and assists the doctor’s office by compiling all required information, finding the correct and specific insurance forms, and handling all communication between patient, doctor’s office, and the insurance company. Ultimately, we want to expedite the process for the patient, while also taking some burden off of the doctor’s office.