| By :
Stephen Daniels
In the words of Mary Poppins, "Just a spoonful of sugar helps the medicine go down." But so do gels, skin patches and troches. The first two delivery methods are probably familiar to most; however, troches may not. A troche is a small lozenge containing bio-identical hormones that is placed between the cheek and gum and dissolves in around 30 minutes. This emulates how the body circulates and processes its own naturally produced hormones. Troches are produced by a compounding pharmacy, which means the staff pharmacists put together customized prescriptions one at a time, instead of thousands a day as is the practice at large commercial drug manufacturers. Mass-produced medications have two hurdles to jump before getting to where they can do the most good: After being swallowed (with or without sugar) they are subjected to the digestive system's acids and start to break down. The next stop is the liver, whose main purpose is to block harmful substances, and to maintain the balance of hormones in the blood stream. It can't recognize that a sudden surge in some hormones is only temporary, so it jumps into action; further diluting the good stuff. It is not just estrogen and progesterone, commonly prescribed for menopausal symptoms, that are affected by the liver's processes, but also other circulating hormones such as thyroid cortisol and a less well known substance, antithrombin III, which protects against strokes and heart attacks. The advantages of patronizing bio-identical hormone pharmacies, which by definition are compounding pharmacies, become clear. These hormones and a troche transportation system are recognized by the body quickly and are sped along in the blood stream for peak efficiency. Compounding pharmacies are an ancient practice that experienced a slump with the rise of the large commercial drug manufacturers. Lately, however, both medical practitioners and their patients have come to realize the benefits of customizing dosages and delivery methods for each individual. Also, a new appreciation of acting in harmony with nature makes this "everything old is new again" idea very appealing. Concerns with insurance payments arise when considering a compounding pharmacy. The reason is that all commercially produced medications are assigned a Natural Drug Code (NDC) by the FDA. So, when insurance plan prescription cards are presented in payment, the process is automated and pretty seamless. At a compounding pharmacy, however, since their medications are assembled on the spot instead of at a factory, they do not have NDCs. That doesn't mean that insurance plans will not pay for them. It just means customers will need to pay for their prescription and then file a claim for reimbursement. With few exceptions, their claims will be honored. Much like a custom made suit, a compounding pharmacy may be the best fit for some prescriptions.
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