All Mixed Up

Capsules, flavors, lollipops, liquids, transdermal gels, suspensions, lozenges, injectables — Penro’s custom pharmacy compounds make sure the medicine goes down

by Virginia Lindauer Simmon

Pharmacist Neal Pease, the owner of Penro Specialty Compounding in Colchester, was a certified flight instructor who studied aircraft maintenance after high school. It wasn’t long before he followed his twin brother to pharmacy school.

Neal Pease is a druggist without a drugstore. Well ... without a traditional drugstore that offers over-the-counter medicines and fills prescriptions. Pease is the president and owner, with his wife, Ro, of Penro Specialty Compounds, a Colchester village operation that prepares medicines one person (or pet) at a time.

“We have what we call a ‘triad relationship,’” says Pease, “where you have the patient, the prescriber and the pharmacy in the relationship. Each prescription is for a particular individual, whether it be an animal or a human. We don’t manufacture in bulk; we don’t sell to other pharmacies.”

Each compound made at Penro is tailored exactly to the patient and his or her needs. For example, says Pease, “When manufacturers prepare medication, they’re fine, but they’re a one-size-fits-all medication. Your physician may find that a different dosage is best for you. We can create a dosage based on your doctor’s specific orders.”

Size and strength aren’t all that matter, though. Animals, as do people, react to various flavors. This can be especially difficult when the medicine must be taken for months or years, perhaps to manage a chronic health problem, Pease says. He can give the medicine a taste that’s friendlier to the patient. Some people have a tough time swallowing pills. Penro might put the medicine in a liquid form or make it into a suppository.

“We do a lot of veterinary compounding,” says Pease, and it’s a lot of fun. All sorts of animals: dogs, cats, horses, turtles, iguanas, birds, rats, mice, ferrets, you name it, we’ve probably prepared a prescription for it.”

As much as he enjoys being a pharmacist — he even worked in a pharmacy called The Apothecary in his native Rutland during high school — Pease confesses that it was not his first choice as a profession. That would have been aircraft maintenance and flight instruction.

While a student at Rutland High School, he was bitten by the flight bug. “I went through all my ratings and became a commercial pilot and a certified flight instructor, which I became when I was 18,” he says.

Following graduation in 1974, he attended an aircraft maintenance school in Maine to become a licensed air frame and power plant mechanic.

It wasn’t long before Pease realized that “it was going to be a long, tough road trying to go that route.”

His twin brother, Earl, was in pharmacy school, and Pease decided to give it a try, enrolling at the Albany College of Pharmacy, part of Union University, in 1976. “It was a five-year program,” he says. “I graduated in 1981.” That was a year after Earl bought the former Terminal Pharmacy, now known as Lakeside Pharmacy in downtown Burlington.

To support himself through college, Pease gave flight instruction and towed gliders. “I became a glider flight instructor during summers and the school year,” he says.

In 1981, Pease married a woman he had met in college.

His bachelor of science in pharmacy in hand, Pease landed a job with Knighte’s Pharmacy in St. Albans. About three years, he took a job with Kinney Drugs at Creek Farm Plaza in Colchester as pharmacy manager.

The Peases have six employees: four in the pharmacy and two who work for Penro Transcription Services, their medical transcription service. Pharmacy technicians are, from left, Vy Le, Ryan Baker and Aaron Desrochers.

During his four years with Kinney Drugs, he opened the first pharmacy in Vermont that was inside an HMO — Community Health Plan in Burlington. After leaving Kinney, he spent a short time working for Scott Brown, the owner of Kelly Pharmacy in Burlington. “He was into compounding,” says Pease, “so I got a little bit of exposure from that.”

It was 1988. Pease and his wife had three children, and they were ready to start their own company. “It was called LTC Pharmacy Services in Williston,” he says. “That stands for long-term care, and was what we call an institutional pharmacy that served nursing homes exclusively. We provided medication and consulting services for nursing homes all over the state.”

The business thrived, but the marriage foundered, and in 1994, Pease left the business and the marriage. After a year as manager of the Wal-Mart pharmacy in Williston, Pease had married again, and he and Ro headed west to San Francisco, where Pease worked as a consultant to long-term-care providers in the Bay Area.

They found themselves lonely for Vermont — “It was a long way out there,” he says — and returned “somewhere in the middle of ’96.”

Back on home territory, Pease worked for a prescription center in Milton, and then went to work again for Wal-Mart, this time in the Berlin pharmacy. “I believe it was during that time that I started to put together this business I have now,” he recalls.

“We started this business in November of 1998, while I was still at Wal-Mart; I operated this part time for several years. Then when it became busy enough to support me, I left Wal-Mart and went full time here, I think in 2002.”

“Here” is an attractively laid-out building behind the Peases’ home in Colchester village. Theoretically, says Pease, they work by appointment, “because everything is custom, but our hours are usually 9 a.m. to 6 p.m. Monday through Friday. We close for lunch between 1 and 2 — it’s more like a professional office situation.”

Pease handles the pharmacy end of things, and Ro takes care of the administrative tasks such as accounting and record keeping.

In the pharmacy, four employees work with the Peases. Another two employees work for Penro Transcription Services, a medical transcription service also owned by the Peases.

“Most of our orders come by telephone,” says Pease, “from all sorts of different prescribers. We do a lot of veterinary, but we also work with regular physicians, osteopaths, naturopathic physicians, who also can prescribe in this state.

“Basically, all day long, we take orders for custom prescriptions. We take the order, then I prepare what we call a formula work sheet, which lists all the ingredients, all the lot numbers, expiration dates, storage requirements, instructions for the technician to put the compound together — all on this worksheet. Then the pharmacy technician actually does the physical manipulation. It could be any kind of dosage form. We do sterile products, injectables, eye ointments, creams, capsules, liquids, flavoring. You name it, we do it.”

A growing part of the business is the compounding of bio-identical hormones. Bio-identical hormone replacement uses natural substances for hormone replacement therapy, Pease says. These natural hormone replacements contain the exact chemical compositions as hormones produced by the human body.

Ro Pease is co-owner of Penro with her husband, Neal. She does the accounting and record keeping, while he handles the pharmacy side.

Because bio-identical, or natural, hormones cannot be patented, pharmaceutical companies are not inclined to take on the research and development costs needed to manufacture them commercially. As a result, says Pease, physicians generally receive limited information on natural progesterone, testosterone, estradiol, estriol and estrone. This therapy, says Pease, is under assault. “Wyeth, which is the manufacturer of hormones like Premarin, which got all this bad press a few years ago, has sent a petition to the FDA trying to get our compounding shut down, because they don’t want the competition.”

To accommodate their growing business, the Peases bought another building, 220 Main St., the former site of a video store.

“We’re outgrowing our location here,” says Pease. “We’ve owned that property for some time and are in the midst of trying to get everything to come together. We’ll renovate the existing building and put the actual pharmacy behind it. We’ll redo the whole property. We’re hoping it will happen in the fall.”

Once settled in the new space, Pease plans to continue to focus on compounding, “and we’re going to be doing bio-identical hormone replacement counseling,” he says. “We’ll also do nutritional counseling and have very high-end nutritional supplements. It’s going to be a beautiful building. It will look like an old-time pharmacy, and we’ll have space to lease, hopefully to professional offices.”

Although he’s not as active in the political end of his business as in the past, when he was president of the Vermont Pharmacists Association, he is a member of the International Academy of Compounding Pharmacists, the National Community Pharmacists Association and Professional Compounding Centers of America. He keeps in top form by traveling to educational symposia and taking more training in compounding, products and nutrition. “That’s something that was never taught in pharmacy school,” he says.

When they can, he and Ro take the occasional long weekend in Maine or, as they did this year, in Williamsburg, Va. Pease has kept up his pilot’s license, and their airplane comes in handy when they want to visit their children and six grandchildren. “With the airplane, we can cover a lot of distance,” says Pease. •