You asked us and we found the answers to your questions. As well, many are topics that come from our own experiences, twenty eight years of experiences in fact here at Stafford Pharmacy & Home Healthcare.
What is compounding?
Compounding is a way for physicians and veterinarians to order individualized medications for their patients.
Compounding is the art of mixing drugs and other ingredients to create customized medications.
What dosage forms can be compounded?
At a Stafford Pharmacy we can create a wide variety of products including:
- Oral Liquids (suspensions/solutions)
- Topical creams and gels
- Suppositories (rectal/vaginal)
- Eye drops
- Intravenous antibiotics and other sterile products
Why might you require a compounded medication?
There are many instances that a medication may need to be compounded. For animals, the appropriate dosage may not be commercially available. If it is available, it may not be in a form the animal will take which may simply mean the change to a more appropriate flavour for your companion animal. At our Stafford Pharmacy & Home Healthcare we can flavour medications for animals so that it will make giving them their medications easier!
For humans, there are many reasons for the preparation of a custom dosage form. There may be no commercially available product, or the product may not be available in the desired strength or dosage form. For example, some people have difficulties swallowing, compounding a medication that is normally available only in a tablet into a liquid. There are many reasons other reasons you may require a compounded prescription as well!
Do I need a prescription for a compounded medication?
Yes. A medication cannot be compounded for you or your animal without a prescription from your physician or veterinarian. The prescription must specify the strength/dose and instructions for use.
How long does it take to prepare a compounded prescription?
Typically we require 24-48 hours to prepare a compounded prescription. However, in emergency situations this timeline is modified.
Are compounds covered by my insurance plan?
Depending on your insurance plan, the majority of compounded medications should be covered. The only plans we are able to bill online to are Alberta Blue Cross and Social Services. For all other plans, you must submit your receipt in order to receive reimbursement for your compounded products.
For additional information about compounding as well as some specifics about the dosage forms we are currently preparing, visit our main compounding introductory page.
Which insulin supplies should you get a prescription for?
Not only do you need a prescription for your insulin if you are a diabetic, but you should also have your doctor write you a prescription for your needles and your test strips.
Why do you need a prescription for these?
In order for drug plans to pay for your insulin supplies like needles and strips, they require a prescription. You can buy these items without a prescription, but they will not be covered by your insurance plan.
What about lancets?
Lancet’s are not covered by any insurance plans at the current time. Therefore you do not require a prescription for lancets because you will have to pay for them either way.
What should be on the prescription?
The prescription should specify how frequently the supplies are to be used (ex. Three times daily or Four times daily etc.). It should also say how many needles and/or strips are being prescribed. The doctor may write this as a quantity (ex. 100) or by duration (ex. 3 months).
How long is a prescription valid for?
The longest possible duration for a single prescription is 18 months from the date it is entered into the pharmacy’s computer. However, the pharmacy can accept a prescription up to one year after the date it was written. Even though you will need these supplies ongoing, the doctor cannot write a prescription for the rest of your life! It is good practice to ask your doctor for a new prescription for your supplies at each doctors visit to ensure your prescription for supplies doesn’t expire.
Ask a member of the pharmacy team about the status of your diabetic supply prescription today!
What is a DIN?
A Drug Identification Number or DIN is an eight digit number assigned to a drug product before it can be marketed in Canada. The Health Canada assigned DIN uniquely identifies each drug on the market in Canada.
Do only prescription drugs have DIN’s?
No, all Health Canada approved drugs including over-the-counter medications have been assigned a DIN.
What is the DIN used for?
A DIN on the medication label lets the consumer know that Health Canada has approved the formulation, labeling, and instructions for use. It is illegal to sell a drug product without a DIN number.
A DIN uniquely identifies the following product characteristics: manufacturer; product name; active ingredient(s); strength(s) of active ingredient(s); pharmaceutical form; route of administration. Additionally, DIN numbers are used by drug insurance companies in order to identify whether or not a drug is covered.
Do Vitamins have DIN’s?
No. However as of January 1st, 2004 these products are required to have other types of identification numbers. Natural health products are assigned either an eight digit natural product number (NPN) or a homeopathic medicine number (DIN-HM).
The process of reviewing and approving all natural health products in Canada is still not complete. Therefore, products which have been initially assessed by Health Canada for safety, quality and efficacy have been given a temporary exemption number which allows them to legally be sold until they are assigned a permanent NPN or DIN-HM. The exemption number is in the form of EN-XXXXXX.
What are the NPN and DIN-HM used for?
These numbers assure the consumer that the product has been approved for sale by Health Canada. They also uniquely identify the same characteristics of the product as the DIN does for drug products.
Why are these numbers important to you?
Health Canada’s approval means that these products have been tested for the following: safety, efficacy and manufacturing standards. Additionally, these products are continuously monitored for adverse effects that occur while they are on the market.
Many products on the internet do not have DIN’s, NPN’s, DIN-HM’s or EN numbers. This means that they have not been approved by Health Canada and are not evaluated for safety.
If you are a diabetic you may have heard conflicting information on whether or not you require a prescription to pick up insulin from a pharmacy.
When isn’t a prescription required?
In Alberta, insulin can be sold to a patient without a prescription. Insulin is in the Schedule 2 drug class. Schedule 2 medications can only be sold in a pharmacy, and they must be kept behind the pharmacy counter. In order to sell a schedule 2 medication, the pharmacist must set up a complete patient profile and ensure the medication is appropriate for the patient.
While insulin is considered schedule 2, it is in this schedule in case of emergency. This means that if you are traveling and run out of insulin, or can’t get in to see your doctor, the pharmacist can maintain your current insulin therapy without sending you to a walk in clinic or emergency. The pharmacist must document the sale of the insulin on your profile, along with any information that helped the pharmacist determine the insulin was appropriate.
When is a prescription required?
The majority of the time (except in the case of an emergency) a pharmacist will not sell insulin without a prescription. The reasons for this are as follows.
- Your drug plan will not cover the cost of the insulin without a prescription from your doctor.
- Your doctor, or a pharmacist with additional prescribing rights must originally write a prescription for a particular type of insulin and at a certain dosage.
- You should have a blood test every 3-6 months in order to determine if the insulin you are using is working as it should be. Following the blood test you should see your doctor to see if any dose adjustments are necessary.
Diabetes is a progressive disease and requires ongoing monitoring and medication adjustments to ensure optimal therapy. If you think your diabetes is not optimally managed speak with your pharmacist or doctor today!
Drug Shortage in Canada!?!
Yes, all across Canada pharmacies are being faced with drug shortages. Since August 2009, the list of generic prescription drugs that are unavailable due to manufacturer shortages continues to grow and grow. Each day across Canada as pharmacists place their orders for medications from manufacturers and wholesalers, there are more and more medications that are simply not available.
What does this mean for our patients and ourselves?
We are doing everything in our power to get any brand of your medication that we can. This means that you may be receiving a new generic brand of your medication. For example, if you were previously receiving Sandoz-Omeprazole, this time you may receive Mylan-Omeprazole. These medications are exactly the same, just made by a different manufacturer and in many cases, there are several manufacturers of any one drug, so we are able to make this simple substitution.
What happens if there are no brands of a particular medication available?
In this instance we attempt to order in the medication in powder form and make the product ourselves. For example, if you have been receiving Novo-metoclopramide 10 mg tablets and we can no longer order any other equivalent brand of this same medication, we have the option of compounding metoclopramide capsules. These formulations are not identical to the commercially available product, however they contain the same active medication at the same dose. Please keep in mind that making these formulations take extra time to prepare. If you can talk to us 3 days to a week before you run our of your medication we can ensure that you do not experience a disruption in your therapy. We continue to be on the look out for these short falls and are continually sourcing pharmaceutical quality chemical ingredients from which to compound custom prepared dosage forms.
What is the worst case scenario?
The worst case scenario is that we can’t get any brand of your medication and we also are unable to compound the medication. In this case, we will do our best to work with your physician to find an alternative therapy that will work the best for your condition.
Please do your best to refill your medications 3-7 days before you will run out. This will help us find alternatives for you if we are having supply problems with a medication that you are taking.
At Stafford Pharmacy we are dedicated to ensuring you receive the best health care. Please feel free to contact us with any questions or concerns regarding this issue.
Pharmacists are the most easily accessible health professionals, however their services continue to be undervalued and underutilized. The pharmacist is considered the drug information expert and their knowledge should be used as such.
How can your pharmacist help you?
Here is a list of things that your pharmacist can help you with!
- Answer questions about your general health, disease prevention, disease, and acute illness
- Assess your condition and determine whether you should see your physician or another health care professional
- Provide advice on the use of over-the-counter medications, vitamins, herbal supplements, homeopathic remedies and prescription medications
- Offer assistance for those trying to quit smoking or reach weight loss (diet and exercise) goals
- Ensure accuracy, appropriateness, safety, effectiveness of the prescription written for you by your physician
- Provide you with information about your prescription medications and give guidance on how to take them appropriately
- Monitor and help manage the treatment of chronic medical conditions such as diabetes or high blood pressure
- Follow-up with you to assess the efficacy and safety of your medications
- Provide methods to make taking your medications easier, and to help you to remember to take your medications
How can I help the pharmacist help me?
In order for your pharmacist to provide the best care for you, they will need to know the answers to some important questions. Here are a few samples of the questions that your pharmacist will ask:
- Demographic information (including Alberta Health Care number)
- Do you have any allergies to any medications?
- What are your past and current medical conditions?
- What medications are you currently taking?
- What symptoms are you currently experiencing?
- Are you using any over-the-counter medications, herbals, or vitamins?
The answers to these questions are extremely important, and help the pharmacist provide advice or treatment properly. Be honest when you answer these questions. The pharmacist cannot share your health information with anyone as they are bound by the privacy act. Withholding your health information from the pharmacist could put you at risk. For example, if the doctor writes a prescription for you for nitroglycerine and you take it to a pharmacy, the pharmacist needs to know what other medications you take. If you take Viagra, but have it filled at another pharmacy and are embarrassed to tell this pharmacist it could result in a life threatening interaction. Never be afraid to talk to your pharmacist, this tip could save your life.
Choose one pharmacy and stick with it.
Your pharmacist is an important part of your healthcare team. The more your pharmacist knows about your health, the better they are able to help. Using only one pharmacy greatly helps to reduce the chance of duplication of therapy and drug interactions. Every year thousands of people are admitted to the hospital because of the improper use of medications. Using one pharmacy ensures the pharmacist is aware of any potential problems with your medication therapy.
How can you ensure you are using your medications safely?
Remember the 3R’s of medication safety.
1) Risk— All medications (over-the-counter and prescription), herbals, and vitamins have risks associated with taking them. Before using anything, check with your pharmacist to ensure that the benefit of the product outweighs the risk.
2) Respect—Respect the power of the medication and its ability to benefit you, but also to cause harm if used inappropriately.
3) Responsibility— Take responsibility to learn about your medications and how to use them correctly. When in doubt ask! There is no such thing as a stupid question!
Have you ever taken a pill and wondered how the drug knew where to go after you swallowed it? Or, how does a heart medication know to go to the heart? Well, the answer is, it doesn’t!
The “lock and key model” shows us how drugs work. In this model, the drug is the key and the receptors for the drug are the locks. Drugs are designed to attach themselves to receptors within the body based on their shape.
Once swallowed, the medication is absorbed into your bloodstream and distributed throughout your body. When it comes into contact with a receptor it recognizes, it binds to the receptor and does one of the following:
- Activates the receptor inducing a response
- Blocks the receptor and prevents a response
There are an unknown number of different receptors in your body. Medications are designed with the goal of only fitting one receptor and thus only activating one type of response. Just like a key is only made to open one specific lock.
If it was possible to create a drug that truly only interacted with one type of receptor in the body, there would be no such thing as side effects.
The problem with the lock and key model is that it is the ideal and not the reality. Unfortunately, while a drug interacts with one receptor more than others, it is also able to interact with unintended receptors that have a similar structure. When a drug binds to a receptor that it isn’t supposed to, the result is an unwanted response or side-effect.
When my doctor writes me a prescription how long is it good for?
The paper prescription that your doctor gives you is valid for 1 year from the date it is written. That being said, the pharmacist can use his/her profession judgement to determine whether or not the prescription should still be used.
For example, if the doctor writes you a prescription for an anti-biotic for an ear infection and you bring it to the pharmacist 6 months later, the pharmacist may refuse to fill the prescription. This is because the antibiotic may not be appropriate for the infection you currently have. Your new condition requires the attention of a physician.
Once you bring you prescription to the pharmacy, how long do you have to fill it?
The majority of prescriptions can be refilled for up to 18 months after it is dropped off at the pharmacy (as long as there are refills). Medications in the controlled and targeted substances group can only be refilled for 1 year after the prescription is dropped off at your pharmacy.
This means that your doctor cannot give you an unlimited amount of refills. If the doctor writes you a prescription for 3 years, or puts 10 refills on the prescription, you will only be able to refill the prescription for up to 18 months (or 1 year) from the day it was brought to the pharmacy.
Why can’t prescriptions be refilled for longer than 18 months?
The laws on how long prescriptions can be filled for are for your protection. It is important to see the doctor for re-assessment to ensure the medication prescribed is still appropriate for you!
When you bring a new prescription in to the pharmacy, it is the pharmacists responsibility to ensure the medication prescribed is appropriate. The pharmacist will check if the medication is correct for the condition being treated. They will check the dose, frequency and duration of the prescribed medication. If an error is found, the prescription may need to be altered before it can be administered to the patient.
The ability of the pharmacist to adapt the prescription prevents the pharmacist from having to call the doctor, or have the patient go back in to see the doctor. This also ensures the medication is started as quickly as possible.
What is a prescription adaptation?
When the pharmacist knows patient well enough, is familiar with the patient’s medical condition being treated and feels confident to assess the patient, they may adapt a prescription if they feel it was written incorrectly or not necessarily written such as to provide the optimal benefit from that drug regimen. For example, the dose of a medication may be too high or too low for a particular patient and therefore, the patient would benefit from an adjustment of that medication dose. This may be an opportunity for the pharmacist to adapt that prescription to improve drug therapy.
I think the dose of my current medication is too low, can the pharmacist increase it?
No. The pharmacist can only adapt brand new prescriptions for a few reasons.
When can the pharmacist change the dose of a NEW prescription?
The pharmacist can alter the dose if the adjustment is required due to the patient’s age, weight, or organ function. For example, if your child weighs 20 kg, but the doctor calculated the dose of their antibiotic based on the weight of the child at the last visit, say 10 kg, then the pharmacist can alter the dose because of the weight.
Why is the pharmacists name on my prescription bottle instead of the doctors?
Once a pharmacist adapts a prescription, the pharmacist becomes the prescriber. The responsibility of the prescribed medication now falls with the pharmacist.
Will my doctor be told about the change made to the prescription?
If the pharmacist changes the dose of the medication they must notify the original prescriber. The pharmacist who changes the dose must notify the doctor of the type and amount of the drug prescribed, the rationale for the change and the instructions to the patient.
Didn’t realize you were out of refills on your prescription? Can’t get in to see your doctor before you will run out? Can your pharmacist help you?
Pharmacists now have the ability to renew your prescription for current and ongoing therapies to ensure treatment is not interrupted.
Will my pharmacist renew my prescription?
MAYBE. It depends on whether or not your pharmacist has enough information about your condition and treatment. When the pharmacist renews your prescription, the pharmacist becomes the prescriber, instead of the doctor. The pharmacist is now responsible for the therapy prescribed.
The pharmacist must ensure that the therapy is: necessary, effective and safe for your condition.
Can the pharmacist renew any prescription?
No. Pharmacists are unable to renew prescriptions for narcotics and other controlled substances at this time.
Can the pharmacist refuse to renew my prescription?
Yes. If the pharmacist does not feel that they have enough information about you and your health status they may refuse to renew your prescription. They may also refuse to renew your prescription if they do not feel that it is a safe and necessary drug therapy for you to be on. That being said, if it is a medication that you normally take and have been taking for a chronic health problem, it is most likely that the pharmacist will not refuse. There pharmacist is here to do what is best for you and is not here to interfere with rational prescribed drug therapy.
Can my pharmacist renew my prescription for an entire year?
No. Pharmacists can renew your prescription for a reasonable length of time which might be 30 days to allow you to see your physician or 3 months if in the judgement of the pharmacist it would be better to extend the prescription for the usual days supply that a prescription refill might last you. You must still see your doctor on a regular basis to obtain your prescriptions. Pharmacists are only able to renew when you are unable to get into the doctor’s office before you run out of refills.
Will my doctor know the pharmacist renew my prescription?
Yes. When a pharmacist renews your prescription they must notify your doctor of exactly what medication was renewed and for how long.
Is there a fee when the pharmacist renews my prescription?
At the introduction of this new service there was were no fees for this service. However, as of July 1, 2012there is a charge for the service but is covered by Alberta Health Services on your behalf, otherwise it is a $20 fee. Please ask your pharmacy staff for more information.
Have you ever wondered why only certain medications are kept behind the counter?
The province of Alberta in conjunction with National Drug Scheduling Advisory Committee decides how drugs are scheduled. The schedule of the drug refers to the category that the drug falls into. There are different regulations that apply to each category. Since provinces have input into how drugs are scheduled, the regulations that apply to drugs may differ between provinces. Drugs are scheduled based on the risk of taking medications with or without the advice of a healthcare professional. Higher risk medications are placed in schedule 1 while lower risk medication are placed in schedule 3.
In Alberta we have three drug schedules:
Schedule 1: Drugs that require a prescription. (eg: Lipitor®, Tylenol® #3, Penicillin)
Schedule 2: Drugs that are available only from the pharmacist and do not require a prescription. These medications are found behind the counter (eg: Gravol®, Iron >30mg, Tylenol® #1). To promote safe drug use, a pharmacist ensures that patients are making appropriate selections. To accomplish this, a pharmacist must provide counseling if needed as well as document the sale. Pharmacists are required to ask for an Alberta Health care number and to make a patient profile in the computer.
Schedule 3: Drugs that are available without a prescription from the self selection area of a pharmacy (eg: Plan B®, vaginal yeast infection products). A pharmacist must be available if patients require advice.
Unscheduled: Drugs not listed in Schedule 1, 2 or 3 may be sold from any retail outlet. You can even find these drugs in a gas station. (e.g.: Tylenol, Aspirin, Ibuprofen)
Why are some drugs behind the counter even though they are listed in schedule 3? Eg. Plan B®
Pharmacies have the ability to store medication behind the counter if they believe that additional counseling is required, or if there is a risk of theft.
Your drug plan pays for a portion or all of your prescription medication, and saves you money. To get the most out of this benefit, and prevent delays at the pharmacy it is important to learn about how your drug plan works.
Who is in charge of your drug plan?
The company where you or the card holder works hires an insurance company to manage the drug plan. Alternatively if you are a senior (over 65), or on social assistance , the provincial government manages the drug plan. To learn about the details of your plan contact your insurance company.
How do I ensure that the pharmacy will bill to my drug plan?
Show your personal drug plan card to a pharmacy staff member when you drop off your prescription. If you have a direct bill plan it will pay for your medication at the pharmacy.
If you have a reimbursement plan (instead of a direct bill plan) you will have to submit your receipts by mail so that the insurance company will pay their share. Your pharmacy will keep your drug plan information on file, so it is not necessary to show your drug plan card to your pharmacy every time you fill a prescription. However, if your plan changes you must provide the pharmacy with updated drug plan information.
How many days of my prescription can I fill at a time?
Each plan allows different amounts of medication to be filled at a time. Some plans allow 100 days while others only allow 30 days. Ask a member of the pharmacy team how many days your plan will allow.
Why are some prescriptions rejected by my drug plan?
Not all medications are covered by drug plans. Additionally, each drug plan is different in which medications they cover. For some there may be a less expensive medication that is covered that will work as well. Your pharmacist may be able to make a recommendation to your doctor for an alternative that would be covered.
Why do I have to pay for my prescription even though I have coverage?
Some drug plans require that you pay a portion of the prescription (co-pay). Other plans require that you pay a deductible every year. For example you must pay the first $200 of prescriptions before your coverage kicks in.
Why won’t my plan pay for my compounded prescription?
We can not bill compounded medication directly (except to Alberta Blue Cross and social services). You will have to submit your receipts by mail to receive reimbursement for any compounded medications.
Do you have expired medications in your medicine cabinet? Confused about how to dispose of them? We can help!
Throwing expired medication into the garbage creates an environmental hazard. Medications that end up in the garbage can end up in our soil, our water, then entering the plants and animals, eventually entering our own food chain. Flushing medications down the toilet used to be considered the best option. We now know that flushed medications end up back in our water supply causing an accumulation in the freshwater fish that inhabit our streams, rivers and lakes. Just another environmental hazard.
What do I with my expired medications?
Bring all of your expired medication back to your pharmacy!! That includes all over-the-counter medications as well as prescription medications. Your pharmacy will ensure that your medications are disposed of in a way that dose not pose a risk to our environment or the health of others!
In Alberta the EnviRx program offers an organized system of safe disposal. Alberta pharmacies have participated on a voluntary basis, to collect these “dead drugs”. These collections of dead drugs are then routinely collected by a company contracted to transport the waste to a disposal site, approved by the provincial government, where the dead drugs are incinerated at extremely high temperature, where even the smoke from incineration is scrubbed of any harmful residues.
Your pharmacist is an active participant in preserving our environment for today and generations to come. For more information about the EnviRx program visit this link to the Alberta Pharmacists Association (RxA) and the EnviRx program.
What is a prescription?
A prescription is a legal document, and therefore must have certain information contained on it to make it such. The following components must be on a prescription:
- Date the prescription was written
- Name and address of the patient
- Name of drug or drug product
- Strength of drug and dosage form
- Route of administration
- Quantity to be dispensed
- Instructions for use
- Number of refills, if any
- The prescriber’s name and phone number
- The prescriber’s signature
How long is a prescription valid for?
The prescription is valid for 1 year from the date that it was written.
Can I photocopy my prescription for personal use?
No. A prescription can not be copied unless done so by a pharmacist. The pharmacist must place appropriate stamps and notes on a copied prescription and sign the copy.
The doctor wrote the prescription on a large piece of paper, can I trim the edges?
No. The paper the doctor wrote on should not be altered in any way. The prescription is your doctor’s communication to the pharmacist.
The doctor made a mistake, can I write on my prescription or cross something out if I don’t need it?
No. If there is a mistake, notify the pharmacist and they will contact the doctor to have it corrected. Altering a legal document, such as a prescription is considered forgery.
Every medication enters the market with two names. The first name is its generic (or chemical) name. The second name is its brand name, usually something catchy and chosen by the manufacturer who has the patent on the medication.
Just like your generic cola versus the brand name Coca-Cola the largest difference between the two is in the price!
Brand name drugs are very costly. This is because the company producing them has spent anywhere from $500 million to $2 billion during the time the medication was discovered/ produced to the time that it gets onto the market. This money is spent on research and development as well as 3 phases of clinical trials required by Health Canada before the medication can be approved. The high cost of new brand name drugs is also what can prevent them from being covered under government insurance plans.
Once the patent on a new drug has expired, generic companies may begin to produce the drug. The generic companies have spent extremely little money on development and require only one trial proving their equivalency to the brand name product before they receive approval for sale from Health Canada. This allows generic companies to price their medications much lower. Additionally, the provincial government regulates how much generic companies can charge for the medication relative to the brand name companies. For example, in Alberta, generic companies making a new generic drug can only charge 45% of the price of the comparable brand name drug.
Brand and generic drugs contain the same active medication. For example Tylenol and generic acetaminophen both contain acetaminophen to decrease your pain or reduce your fever. However, they likely contain different “fillers”, or inactive ingredients. They also may vary slightly different in size, shape and color. Despite these differences, the brand and generic should work to treat your condition exactly the same!!