How Compounding Has Become a Permanent Bridge for Healthcare Access: Q&A with Dr. Nicole Snow

In March, Pharmaceutical Executive reported on Eli Lilly’s efforts to push back against the availability of compounded GLP-1 medications. According to the company, testing had identified a specific issue caused when tirzepatide is compounded with certain B12 variants. This impurity could reportedly cause both long-term and short-term effects.

This is just one example of the industry’s efforts to control compounded pharmaceuticals. However, there are also many in the industry that champion these practices. Dr. Nicole Snow, senior clinical pharmacist at Wesley Pharmaceuticals (sister company to Olympia Pharmaceuticals) spoke with Pharmaceutical Executive about the importance and impact of compounded pharmaceuticals.

According to her, these medications play a key role in closing care gaps and supporting optimal outcomes.

Pharmaceutical Executive: How does compounding help close care gaps?
Dr. Nicole Snow: This is a great question! As we have seen over the past couple of years, compounding products helps bring medications and products to a wide population. Compounding plays a critical role in closing care gaps by enabling truly individualized medication therapy when commercially available options fall short. Many patients - particularly pediatric, geriatric, or those with renal or hepatic impairment - require customized dosing that isn’t available in standard manufactured products. Compounding also allows for alternative dosage forms such as liquids, transdermal, troches, or suppositories, which are essential for patients who have difficulty swallowing, absorption issues, or intolerance to certain ingredients. Additionally, compounded formulations can be tailored to exclude allergens like dyes, preservatives, lactose, or gluten, ensuring safer and more tolerable therapy for sensitive populations.

Compounding further addresses gaps in access and continuity of care during drug shortages or when medications are discontinued, allowing pharmacists to recreate essential therapies and prevent interruptions in treatment. It is especially valuable for underserved populations, including those requiring hormone replacement therapy or dermatologic treatments, where personalized formulations improve both adherence and therapeutic outcomes. By combining multiple medications into a single dosage form, compounding can also reduce pill burden and enhance compliance, particularly in patients managing complex or chronic conditions.

PE: Does compounding support optimal outcomes for patients?
Snow: Compounding can support optimal patient outcomes by enabling therapy to be tailored to the individual rather than constrained by standardized, commercially available products. By customizing dose, dosage form, and excipients, compounded medications improve tolerability, bioavailability, and ease of administration, which directly enhances adherence - a key driver of clinical success. Patients who are unable to use conventional products due to allergies, swallowing difficulties, or absorption issues can still receive effective treatment through alternative formulations. In addition, compounding provides solutions during drug shortages or when specific therapies are discontinued, ensuring patients do not experience gaps in treatment. When performed within appropriate quality and regulatory frameworks and guided by clinical judgment, compoundinghelps optimize therapeutic effectiveness, safety, and overall patient-centered outcomes.

PE: What impact does compounding have on areas such as hormone therapy, IV nutrition, and weight management?
Snow: By enabling highly individualized treatment approaches that align with each patient’s unique physiology, goals, and tolerability, compounding has a significant impact on these areas. In hormone therapy, particularly bioidentical hormone replacement therapy (BHRT), compounding allows for precise adjustment of hormone combinations, strengths, and delivery methods - such as creams, tablets, or injections - supporting improved symptom control and patient satisfaction compared to fixed commercial options.

In IV nutrition, compounding provides the flexibility to design targeted infusion therapies that combine vitamins, minerals, amino acids, and antioxidants (e.g., NAD+, glutathione, B-complex) based on specific clinical needs like fatigue, immune support, recovery, or metabolic health, which can enhance therapeutic response and overall wellness outcomes. In weight management, compounded medications and adjunct therapies can be tailored to support metabolism, energy balance, and body composition, often integrating customized dosing strategies, combination therapies, or alternative delivery routes to improve adherence and minimize side effects. Across these areas, compounding supports a more precise, patient-centered model of care, helping optimize effectiveness, improve tolerability, and address gaps where standardized therapies may be limited.

PE: What are ways that compounding pharmacies are able to help patients with unique issues related to their medications?
Snow: Compounding pharmacies help patients with unique medication-related challenges by helping to address individual clinical needs not met by commercially available products. They can adjust strengths to provide precise dosing for pediatric, geriatric, or medically complex patients, and prepare alternative dosage forms for those who have difficulty swallowing or have absorption issues. Compounding also allows removal of problematic excipients like dyes, preservatives, or allergens, improving tolerability for sensitive patients.

In addition, pharmacists can combine multiple medications into a single formulation to reduce pill burden and improve adherence or modify the route of administration to bypass gastrointestinal side effects or first-pass metabolism. Compounding pharmacies also play a critical role during drug shortages or when medications are discontinued by recreating essential therapies to maintain continuity of care. Through close collaboration with prescribers, they can tailor treatments for specialized needs such as hormone therapy, dermatologic conditions, pain management, or veterinary care, ultimately helping patients achieve safer, more effective, and more personalized therapeutic outcomes.