Almost everyone in healthcare is aware of the debacle of New England Compounding Center beginning in 2012 causing over 800 cases of meningitis and 76 deaths. That case and others like it brought a magnifying glass onto the role of compounding pharmacies that have been creating medications on an ad hoc basis that many times are not available in anyway. Due to the small batches created (often a single unit) quality and cost is highly variable. Surely, it is just that irresponsible pharmacists operating these be shut down and in some cases prosecuted. However, in my experience there are many more really terrific people operating these establishments with the goal of helping doctors and their patients with remedies that are unavailable otherwise.
In my specialty, ophthalmology, the use of compounded medication is standard of care. From avastin for retinal disease to fortified antibiotics to treat severe corneal ulcers we use compounding pharmacies all of the time. Unfortunately, do to the costs of complying with increased enforcement many have had to close their compounding operations. Oversight of these operations is obviously necessary and important but so is our ability to obtain sight saving medications in a timely fashion. I have recently moved from a large metro area with 3 compounding pharmacies to a more rural area (West Virginia) which is now down to a single establishment, as far as I am aware.
It seems to me that one solution is to encourage hospitals to fill the gap. They have the resources and experience to easily meet the necessary standards. Their inflated cost structure would need to be reckoned with and somehow still motivate them to add this service or support those in the private sector who are still hanging in there.