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Order ED Injectable Prescriptions

Prescribers may submit ED injection prescriptions to Bayview Pharmacy by faxing the completed order form, e-prescribing through their EHR, or calling the prescription directly into the pharmacy.
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Fastest Way to Prescribe

Use the ED Injection Order Form or include the Bayview formulation code when e-prescribing.

For the clearest workflow, download the ED Injection Order Form, choose the Bayview formulation code, complete the directions/SIG, and fax the signed order. If e-prescribing, include the formulation code plus the full formulation, quantity, refills, syringe request if needed, and complete directions.

Prescribing Options

Bayview Pharmacy accepts ED injectable prescriptions by faxed order form, e-prescribe, or direct phone call from the prescriber’s office. If your patient declines or cannot use an injection, see the needle-free urethral gels below.

Fax Workflow

Fax the Order Form

Download the ED injection prescription order form, complete all required sections, and fax the signed order to Bayview Pharmacy.

Download Order Form
EHR Workflow

E-prescribe

Search for Bayview Pharmacy, Warwick, RI in your EHR. Enter the full compound formulation, quantity, refills, syringes if needed, and complete directions.

View E-prescribe Instructions
Direct Support

Call It In

Prescribers or authorized office staff may call Bayview Pharmacy directly for prescription submission, clarification, titration questions, or refill coordination.

Call 401-284-4505

Fax Order Form

Download the ED injection prescription order form, complete all required sections, and fax the signed order to Bayview Pharmacy.

The order form should include patient information, prescriber information, medication selection, quantity, refills, syringe selection if needed, directions/SIG, prescriber signature, and date.

Fax Order Form

Download ED Injection Order Form

Download the ED injection prescription order form, complete all required sections, and fax the signed order to Bayview Pharmacy.

Download PDF

The download includes the fax cover sheet, completion instructions, an e-prescribing reference page, and the order form itself. Pharmacy name and fax number must be completed by the prescriber’s office — they cannot be pre-printed on the order form.

E-prescribing

Prescribers may also send ED injectable prescriptions electronically through their EHR. Because compounded medications may not appear as a standard drug selection, the prescription should be entered using the compound, custom medication, or free-text prescription option available in the EHR.

In your EHR, search for:

Bayview Pharmacy
3844 Post Road, Warwick, RI 02886
NCPDP: 4106882
NPI: 1750455143

When e-prescribing a compounded ED injectable, include the same core information shown on the fax order form: medication group, specific formulation and strength, quantity, refills, syringe selection if needed, complete directions/SIG, maximum dose, and maximum weekly frequency when titration instructions are used.

To speed up e-prescribing, prescribers may include the Bayview Pharmacy formulation code from the order form. Codes run A1–A2 for Alprostadil, BM1–BM6 for Bimix, TM1–TM27 for Trimix, QM1–QM26 for Quadmix, and ATM1–ATM3 for Atropine Trimix — the full list with concentrations is in the formulation codes table below. The code should be included with the full formulation details so the pharmacy can verify the intended medication and strength.

Recommended Format

What to Include When E-prescribing

Formulation code

Include the Bayview Pharmacy order code when available, such as A1, BM3, TM9, TM14, QM4, QM5, or ATM1.

Medication group

Alprostadil, Bimix, Trimix, Quadmix, Atropine Trimix, or custom ED injectable formulation

Specific formulation/strength

List each active ingredient and strength exactly as intended.

Quantity

Specify vial size and number of multi-dose vials.

Refills

Specify number of refills, PRN, or no refills.

Syringes

Specify 30 gauge syringes and preferred size if syringes are needed.

Directions/SIG

Include starting dose, titration increment, maximum dose, and maximum weekly frequency.

Additional notes

Include any patient-specific clarification, counseling notes, or special instructions.

Formulation Codes

Formulation Codes

Use the Bayview code to speed up EHR entry.

Bayview formulation codes are shorthand identifiers tied to the ED injection options on the order form. The code helps the pharmacy identify the intended formula quickly, but the full formulation details should still be included so the prescription can be verified before compounding. Every standard code is listed below — select a medication group to jump to its concentrations, or open the formulation page for full prescribing detail, storage, and counseling notes.

A

Alprostadil

2 strengths BM

Bimix

6 strengths TM

Trimix

27 strengths QM

Quadmix

26 strengths ATM

Atropine Trimix

3 strengths
A

Alprostadil

Single-active prostaglandin. The most widely studied intracavernosal option.

View Alprostadil formulation page
Enter as ALPROSTADIL followed by the concentrations below. All options are dispensed in 2.5 mL multi-dose vials. Options marked On order form are the $100 standard strengths printed on the fax order form; every other validated strength is $150 per vial and is ordered on the CUSTOM line.
CodeAlprostadilPer 2.5 mL vial
A1 On order form20 mcg/mL$100
A240 mcg/mL$150
BM

Bimix

Alprostadil-free. Often chosen when alprostadil causes penile pain.

View Bimix formulation page
Enter as BI-MIX followed by the concentrations below. All options are dispensed in 2.5 mL multi-dose vials. Options marked On order form are the $100 standard strengths printed on the fax order form; every other validated strength is $150 per vial and is ordered on the CUSTOM line.
CodePapaverinePhentolaminePer 2.5 mL vial
BM130 mg/mL0.5 mg/mL$150
BM2 On order form30 mg/mL1 mg/mL$100
BM3 On order form30 mg/mL2 mg/mL$100
BM430 mg/mL3 mg/mL$150
BM530 mg/mL4 mg/mL$150
BM630 mg/mL6 mg/mL$150
TM

Trimix

The most commonly prescribed combination. Twenty-seven validated concentrations for titration.

View Trimix formulation page
Enter as TRI-MIX followed by the concentrations below. All options are dispensed in 2.5 mL multi-dose vials. Options marked On order form are the $100 standard strengths printed on the fax order form; every other validated strength is $150 per vial and is ordered on the CUSTOM line.
CodeAlprostadilPapaverinePhentolaminePer 2.5 mL vial
TM12.5 mcg/mL30 mg/mL4 mg/mL$150
TM2 On order form5 mcg/mL30 mg/mL1 mg/mL$100
TM35 mcg/mL30 mg/mL4 mg/mL$150
TM4 On order form10 mcg/mL30 mg/mL1 mg/mL$100
TM510 mcg/mL30 mg/mL2 mg/mL$150
TM610 mcg/mL30 mg/mL4 mg/mL$150
TM712.5 mcg/mL30 mg/mL1 mg/mL$150
TM8 On order form20 mcg/mL30 mg/mL1 mg/mL$100
TM9 On order form20 mcg/mL30 mg/mL2 mg/mL$100
TM10 On order form30 mcg/mL30 mg/mL1 mg/mL$100
TM11 On order form30 mcg/mL30 mg/mL2 mg/mL$100
TM1230 mcg/mL30 mg/mL3 mg/mL$150
TM13 On order form40 mcg/mL30 mg/mL1 mg/mL$100
TM14 On order form40 mcg/mL30 mg/mL2 mg/mL$100
TM1540 mcg/mL30 mg/mL3 mg/mL$150
TM1640 mcg/mL30 mg/mL4 mg/mL$150
TM1750 mcg/mL30 mg/mL1.5 mg/mL$150
TM1850 mcg/mL30 mg/mL2 mg/mL$150
TM1950 mcg/mL30 mg/mL5 mg/mL$150
TM2060 mcg/mL30 mg/mL2 mg/mL$150
TM2160 mcg/mL30 mg/mL3 mg/mL$150
TM2260 mcg/mL30 mg/mL4 mg/mL$150
TM2360 mcg/mL30 mg/mL6 mg/mL$150
TM2470 mcg/mL30 mg/mL4 mg/mL$150
TM2580 mcg/mL30 mg/mL2 mg/mL$150
TM26100 mcg/mL30 mg/mL3 mg/mL$150
TM27100 mcg/mL30 mg/mL6 mg/mL$150
QM

Quadmix

Typically reserved for an inadequate response to Trimix.

View Quadmix formulation page
Enter as QUAD-MIX followed by the concentrations below. All options are dispensed in 2.5 mL multi-dose vials. Options marked On order form are the $100 standard strengths printed on the fax order form; every other validated strength is $150 per vial and is ordered on the CUSTOM line.
CodeAlprostadilAtropinePapaverinePhentolaminePer 2.5 mL vial
QM12.5 mcg/mL0.15 mg/mL30 mg/mL4 mg/mL$150
QM27.5 mcg/mL0.3 mg/mL30 mg/mL4 mg/mL$150
QM320 mcg/mL0.15 mg/mL30 mg/mL1 mg/mL$150
QM4 On order form20 mcg/mL0.15 mg/mL30 mg/mL2 mg/mL$100
QM5 On order form30 mcg/mL0.15 mg/mL30 mg/mL2 mg/mL$100
QM6 On order form40 mcg/mL0.15 mg/mL30 mg/mL2 mg/mL$100
QM740 mcg/mL0.15 mg/mL30 mg/mL3 mg/mL$150
QM840 mcg/mL0.15 mg/mL30 mg/mL4 mg/mL$150
QM940 mcg/mL0.3 mg/mL30 mg/mL2 mg/mL$150
QM1050 mcg/mL0.15 mg/mL30 mg/mL2 mg/mL$150
QM1150 mcg/mL0.15 mg/mL30 mg/mL4 mg/mL$150
QM1250 mcg/mL0.15 mg/mL30 mg/mL5 mg/mL$150
QM1360 mcg/mL0.15 mg/mL30 mg/mL2 mg/mL$150
QM1460 mcg/mL0.15 mg/mL30 mg/mL4 mg/mL$150
QM1560 mcg/mL0.2 mg/mL30 mg/mL3 mg/mL$150
QM1660 mcg/mL0.3 mg/mL30 mg/mL4 mg/mL$150
QM1760 mcg/mL0.3 mg/mL30 mg/mL6 mg/mL$150
QM1870 mcg/mL0.15 mg/mL30 mg/mL2 mg/mL$150
QM1980 mcg/mL0.15 mg/mL30 mg/mL2 mg/mL$150
QM2080 mcg/mL0.3 mg/mL30 mg/mL4 mg/mL$150
QM2180 mcg/mL0.3 mg/mL30 mg/mL6 mg/mL$150
QM2280 mcg/mL0.4 mg/mL30 mg/mL6 mg/mL$150
QM2390 mcg/mL0.15 mg/mL30 mg/mL2 mg/mL$150
QM24100 mcg/mL0.15 mg/mL30 mg/mL6 mg/mL$150
QM25120 mcg/mL0.3 mg/mL30 mg/mL6 mg/mL$150
QM26120 mcg/mL0.4 mg/mL30 mg/mL6 mg/mL$150
ATM

Atropine Trimix

Alprostadil-free three-drug option with atropine added.

View Atropine Trimix formulation page
Enter as ATROPINE TRI-MIX followed by the concentrations below. All options are dispensed in 2.5 mL multi-dose vials. Options marked On order form are the $100 standard strengths printed on the fax order form; every other validated strength is $150 per vial and is ordered on the CUSTOM line.
CodeAtropinePapaverinePhentolaminePer 2.5 mL vial
ATM10.15 mg/mL30 mg/mL2 mg/mL$150
ATM20.3 mg/mL30 mg/mL4 mg/mL$150
ATM30.3 mg/mL30 mg/mL6 mg/mL$150
Best practice: Include both the code and the full formulation. Example: TM9 TRI-MIX: Alprostadil 20 mcg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL. Every code above is a validated Bayview formulation. The 14 strengths printed on the order form are $100 per 2.5 mL vial; all other validated strengths are $150 per 2.5 mL vial — see the formulation pricing notice below.

EHR Ordering Tips

Because each EHR handles compounded prescriptions differently, the exact screen names may vary. In most systems, the office should look for a compound medication, custom medication, miscellaneous medication, or free-text prescription option.

To help Bayview Pharmacy process the prescription quickly, include the Bayview formulation code from the formulation codes table, such as A1, BM3, TM9, QM4, or ATM1, along with the full formulation details.

Quick rule: If the EHR does not have a clean compound medication workflow, use the free-text or notes field to enter the Bayview formulation code, full formulation, quantity, refills, syringe request, and complete SIG.

Select your EHR below for practical tips on entering compounded ED injectable prescriptions. Screen names vary by practice setup, but the same prescription elements should be included in every system.

Epic / Hyperspace +
Suggested Epic workflow
  1. Open the patient chart and start a new outpatient medication order.
  2. Select Bayview Pharmacy, Warwick, RI as the destination pharmacy.
  3. Search for a compound, custom medication, miscellaneous medication, or free-text medication option available in your Epic build.
  4. If Epic allows a medication name field, enter the Bayview formulation code first, followed by the full formulation.
  5. Use the SIG field for the injection directions, titration increment, maximum dose, and maximum weekly frequency.
  6. Use pharmacy notes or comments for syringe request, vial count, and clarification notes if those fields do not fit in the SIG.
Medication name example:
TM9 TRI-MIX: Alprostadil 20 mcg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL
SIG example:
Inject ____ mL intracavernosally as directed. If desired result is not achieved, may increase by ____ mL per dose. Do not exceed ____ mL per dose or ____ times per week.
Pharmacy notes example:
Dispense ____ x 2.5 mL multi-dose vial(s). Include 30 gauge syringes: _____. Bayview formulation code: TM9.
Epic workflows vary widely by health system build. If compound/free-text medication ordering is unavailable, fax the completed ED Injection Order Form or call Bayview Pharmacy.
eClinicalWorks +
Suggested eClinicalWorks workflow
  1. Open the patient chart and go to the medication or eRx workflow.
  2. Select Bayview Pharmacy, Warwick, RI as the pharmacy.
  3. Look for a compound, custom, miscellaneous, or free-text medication option.
  4. In the medication field, enter the formulation code and full formulation together.
  5. Use the directions field for dose, titration, max dose, and max weekly frequency.
  6. Use notes for vial quantity, syringe size, and any patient-specific clarification.
Medication field example:
BM3 BI-MIX: Papaverine 30 mg/mL + Phentolamine 2 mg/mL
Quantity/refills example:
Quantity: ____ x 2.5 mL multi-dose vial(s). Refills: ____.
Directions example:
Inject ____ mL intracavernosally as directed. May increase by ____ mL if needed. Do not exceed ____ mL per dose or ____ times weekly.
If eClinicalWorks does not allow the full compound to be sent cleanly, enter the full details in the notes field or use the fax order form.
athenahealth +
Suggested athenahealth workflow
  1. Open the patient chart and start a new prescription.
  2. Search for Bayview Pharmacy, Warwick, RI.
  3. Use the custom medication, unlisted medication, or free-text entry option if available.
  4. Enter the Bayview formulation code and full formulation in the medication name or prescription notes field.
  5. Include quantity, refills, syringe request, dose, titration increment, max dose, and max weekly frequency.
  6. If the system restricts compound entry, fax the completed ED Injection Order Form instead.
Medication text example:
QM4 QUAD-MIX: Alprostadil 20 mcg/mL + Atropine 0.15 mg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL
Notes field example:
Dispense ____ x 2.5 mL multi-dose vial(s). Refills: ____. Include 30 gauge syringes if requested. Follow SIG below.
SIG example:
Inject ____ mL intracavernosally as directed. If desired result is not achieved, increase in increments of ____ mL. Max ____ mL per dose. Use no more than ____ times per week.
Athena workflows may restrict compound or unlisted medication entry depending on configuration. If the prescription cannot be entered clearly, use fax or call-in.
AdvancedMD +
Suggested AdvancedMD workflow
  1. Open the patient chart and select the e-prescribing workflow.
  2. Choose Bayview Pharmacy, Warwick, RI as the pharmacy.
  3. Use compound, custom, miscellaneous, or free-text medication entry if available.
  4. Enter the Bayview code at the start of the medication name.
  5. Use notes or SIG to include the complete formulation, quantity, refills, syringes, titration directions, max dose, and max weekly frequency.
Medication name example:
TM4 TRI-MIX: Alprostadil 10 mcg/mL + Papaverine 30 mg/mL + Phentolamine 1 mg/mL
Dispense example:
Dispense ____ x 2.5 mL multi-dose vial(s). Refills: ____.
Directions example:
Inject ____ mL intracavernosally as directed. May increase by ____ mL as needed. Do not exceed ____ mL per dose or ____ uses per week.
If the medication field is too restrictive, put the full compound details in the notes field and call Bayview Pharmacy if clarification is needed.
Tebra / Kareo +
Suggested Tebra / Kareo workflow
  1. Open the patient chart and create a new prescription.
  2. Select Bayview Pharmacy, Warwick, RI.
  3. Use custom medication, compound, or free-text entry if available.
  4. Start the medication entry with the Bayview formulation code.
  5. Include the full formulation, quantity, refills, syringes, dose, titration, max dose, and max weekly frequency.
Medication example:
A1 ALPROSTADIL: Alprostadil 20 mcg/mL
Complete entry example:
A1 ALPROSTADIL: Alprostadil 20 mcg/mL. Dispense ____ x 2.5 mL multi-dose vial(s). Refills: ____. Syringes: 30 gauge, ____.
SIG example:
Inject ____ mL intracavernosally as directed. If inadequate response, increase by ____ mL. Max ____ mL per dose. Use no more than ____ times weekly.
If Tebra/Kareo does not permit the compounded entry, fax the order form or call the prescription into Bayview Pharmacy.
DrChrono +
Suggested DrChrono workflow
  1. Open the patient chart and go to the Send eRx workflow.
  2. Select the compound prescription type if available.
  3. Select Bayview Pharmacy, Warwick, RI.
  4. Enter the Bayview formulation code and each ingredient/strength.
  5. Enter SIG, quantity, refills, and syringe request before previewing and sending.
Compound name example:
ATM1 ATROPINE TRI-MIX: Atropine 0.15 mg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL
Ingredient structure example:
Atropine 0.15 mg/mL
Papaverine 30 mg/mL
Phentolamine 2 mg/mL
SIG example:
Inject ____ mL intracavernosally as directed. Increase by ____ mL if needed. Max ____ mL per dose. Use no more than ____ times per week.
DrChrono has documented compound prescription workflows, but configuration may vary by practice. If the compound workflow is not available, use free-text, fax, or call-in.
NextGen +
Suggested NextGen workflow
  1. Open the patient chart and start a new medication prescription.
  2. Select Bayview Pharmacy, Warwick, RI.
  3. Look for compound, custom, miscellaneous, or free-text medication entry.
  4. Enter the formulation code at the start of the medication name.
  5. Add complete formulation, quantity, refills, syringe request, SIG, titration limits, and max weekly frequency.
Medication name example:
TM2 TRI-MIX: Alprostadil 5 mcg/mL + Papaverine 30 mg/mL + Phentolamine 1 mg/mL
Notes example:
Dispense ____ x 2.5 mL vial(s). Refills: ____. Syringes: 30 gauge, ____ size if needed.
SIG example:
Inject ____ mL intracavernosally as directed. May titrate upward by ____ mL. Do not exceed ____ mL per dose or ____ injections per week.
If the compound cannot be transmitted cleanly, use the fax order form for the clearest prescription record.
ModMed +
Suggested ModMed workflow
  1. Open the patient chart and start an e-prescription.
  2. Choose Bayview Pharmacy, Warwick, RI.
  3. Use custom, compound, or free-text medication workflow if available.
  4. Enter the Bayview formulation code and complete ED injection formulation.
  5. Include directions, quantity, refills, syringe request, titration, max dose, and max weekly frequency.
Medication text example:
BM2 BI-MIX: Papaverine 30 mg/mL + Phentolamine 1 mg/mL
Directions example:
Inject ____ mL intracavernosally as directed. If desired result is not achieved, increase by ____ mL. Do not exceed ____ mL per dose or ____ times weekly.
Pharmacy note example:
Bayview formulation code: BM2. Dispense ____ x 2.5 mL vial(s). Refills: ____. Include syringes if selected.
If the office cannot locate a compound entry option, fax the completed ED Injection Order Form.
Practice Fusion +
Suggested Practice Fusion workflow
  1. Open the patient chart and select the prescription/eRx workflow.
  2. Choose Bayview Pharmacy, Warwick, RI.
  3. Use custom medication or free-text medication entry if available.
  4. Enter the Bayview formulation code and full formulation details.
  5. Include full SIG, quantity, refills, syringe request, maximum dose, and maximum weekly frequency.
Medication text example:
QM5 QUAD-MIX: Alprostadil 30 mcg/mL + Atropine 0.15 mg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL
SIG example:
Inject ____ mL intracavernosally as directed. Increase by ____ mL if needed. Max ____ mL per dose. Use no more than ____ times per week.
Dispense/refill example:
Dispense ____ x 2.5 mL multi-dose vial(s). Refills: ____. Syringes: 30 gauge, ____ if needed.
If the eRx does not allow the full compound details, fax the order form or call Bayview Pharmacy.
Veradigm / Allscripts +
Suggested Veradigm / Allscripts workflow
  1. Open the patient chart and create a new prescription.
  2. Select Bayview Pharmacy, Warwick, RI.
  3. Look for compound, custom, miscellaneous, or free-text medication entry.
  4. Enter the Bayview formulation code and complete formulation.
  5. Include quantity, refills, syringes if needed, complete directions, max dose, and max weekly frequency.
Medication name example:
TM14 TRI-MIX: Alprostadil 40 mcg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL
Pharmacy notes example:
Bayview formulation code TM14. Dispense ____ x 2.5 mL vial(s). Refills: ____. Syringes requested: ____.
SIG example:
Inject ____ mL intracavernosally as directed. If inadequate response, increase by ____ mL. Do not exceed ____ mL per dose or ____ injections weekly.
If the compound cannot be sent cleanly, fax the ED Injection Order Form to avoid delay.

E-prescribe Examples

Use the examples below as formatting guides when entering ED injectable compounds in an EHR. The Bayview formulation code helps identify the intended formula quickly, but the full formulation details should still be included for verification.

Alprostadil Example

Code: A1

Medication: ALPROSTADIL: Alprostadil 20 mcg/mL

Quantity: ____ x 2.5 mL multi-dose vial(s)

Refills: ____

Syringes: 30 gauge, specify syringe size if needed

Directions: Inject ____ mL intracavernosally as directed. If desired result is not achieved, dose may be increased in increments of ____ mL, not to exceed ____ mL. Use no more than ____ times per week.

All Alprostadil Injection strengths & prescribing details

Bimix Example

Code: BM3

Medication: BI-MIX: Papaverine 30 mg/mL + Phentolamine 2 mg/mL

Quantity: ____ x 2.5 mL multi-dose vial(s)

Refills: ____

Syringes: 30 gauge, specify syringe size if needed

Directions: Inject ____ mL intracavernosally as directed. If desired result is not achieved, dose may be increased in increments of ____ mL, not to exceed ____ mL. Use no more than ____ times per week.

All Bimix Injection strengths & prescribing details

Trimix Example

Code: TM9

Medication: TRI-MIX: Alprostadil 20 mcg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL

Quantity: ____ x 2.5 mL multi-dose vial(s)

Refills: ____

Syringes: 30 gauge, specify syringe size if needed

Directions: Inject ____ mL intracavernosally as directed. If desired result is not achieved, dose may be increased in increments of ____ mL, not to exceed ____ mL. Use no more than ____ times per week.

All Trimix Injection strengths & prescribing details

Quadmix Example

Code: QM4

Medication: QUAD-MIX: Alprostadil 20 mcg/mL + Atropine 0.15 mg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL

Quantity: ____ x 2.5 mL multi-dose vial(s)

Refills: ____

Syringes: 30 gauge, specify syringe size if needed

Directions: Inject ____ mL intracavernosally as directed. If desired result is not achieved, dose may be increased in increments of ____ mL, not to exceed ____ mL. Use no more than ____ times per week.

All Quadmix Injection strengths & prescribing details

Atropine Trimix Example

Code: ATM1

Medication: ATROPINE TRI-MIX: Atropine 0.15 mg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL

Quantity: ____ x 2.5 mL multi-dose vial(s)

Refills: ____

Syringes: 30 gauge, specify syringe size if needed

Directions: Inject ____ mL intracavernosally as directed. If desired result is not achieved, dose may be increased in increments of ____ mL, not to exceed ____ mL. Use no more than ____ times per week.

All Atropine Trimix Injection strengths & prescribing details

Custom Strength Example

Code: Use the validated code (e.g. TM18, QM13, ATM2) — $150 per 2.5 mL vial

Medication: ED INJECTION COMPOUND: [Active ingredient] ____ + [Active ingredient] ____ + [Active ingredient] ____

Quantity: ____ x 2.5 mL multi-dose vial(s)

Refills: ____

Syringes: 30 gauge, specify syringe size if needed

Directions: Inject ____ mL intracavernosally as directed. If desired result is not achieved, dose may be increased in increments of ____ mL, not to exceed ____ mL. Use no more than ____ times per week.

Verification note: The Bayview formulation code is intended to speed up prescription entry. The full formulation, quantity, directions, and refill information should still be included so the pharmacy can verify the prescription before compounding.

Formulation Pricing

Standard strengths — $100 per 2.5 mL multi-dose vial. The 14 options printed on the ED Injection Order Form (A1, BM2, BM3, TM2, TM4, TM8, TM9, TM10, TM11, TM13, TM14, QM4, QM5, and QM6) are Bayview’s most commonly prescribed ED injectables.

Other validated strengths — $150 per 2.5 mL multi-dose vial. Every other code in the formulation codes table above is a validated Bayview formulation, tested to the applicable USP <797> requirements. Order these on the CUSTOM line of the order form, or include the code when e-prescribing.

Formulations that are not on the validated list may still be compounded when clinically appropriate, but they require additional pharmacist review and pricing is quoted case by case. To avoid delays or unexpected pricing, include the closest applicable formulation code along with the full formulation, quantity, directions, and refill information.

Needle-Free Alternatives

For patients who decline or cannot use intracavernosal injection, Bayview Pharmacy also compounds two urethral gels. These are prescribed and submitted the same way as the injectables — by fax order form, e-prescribe, or phone — but each gel has its own order form and its own strengths.

Needle-Free · Intraurethral

Bimix Urethral Gel

The same two actives as Bimix injection — papaverine and phentolamine — in a gel. Alprostadil-free. Dosed as a single 0.25 mL application.

FormulationPapaverinePhentolamine
Bimix Gel 17.5 mg/mL1 mg/mL
Bimix Gel 27.5 mg/mL2 mg/mL
Download Order Form Prescribing details
Needle-Free · Intraurethral

Triple-P Urethral Gel

Alprostadil, papaverine, and phentolamine in a gel, in four alprostadil strengths. Dosed as a single 0.25 mL application.

FormulationAlprostadilPapaverinePhentolamine
Triple-P 250250 mcg/mL7.5 mg/mL1 mg/mL
Triple-P 500500 mcg/mL7.5 mg/mL1 mg/mL
Triple-P 750750 mcg/mL7.5 mg/mL1 mg/mL
Triple-P 10001000 mcg/mL7.5 mg/mL1 mg/mL
Download Order Form Prescribing details
SIG example: Instill 0.25 mL into the urethral opening 10–15 minutes before intercourse. Do not exceed 1 dose per 24 hours. Include the formulation name and full concentrations, quantity as number of doses, refills, and an ICD-10 diagnosis code.

Avoid Delays

Avoid Clarification Delays

Before sending the prescription, check for these common missing items.

Complete prescriptions allow Bayview Pharmacy to review, prepare, and coordinate the medication more efficiently. Missing details may require pharmacist clarification before compounding.

1

Missing patient date of birth or contact information

2

Missing prescriber signature or date on faxed orders

3

No quantity, vial size, or number of vials specified

4

No refill authorization or unclear refill instructions

5

No starting dose, titration increment, or maximum dose

6

No maximum weekly frequency included in the SIG

7

Formulation code included without full formulation details

8

Custom strength submitted without enough clarification

9

Syringe size not specified when syringes are requested

Prefer the Fax Form?

Download the ED Injection Order Form

The fax order form is often the clearest option for ED injection prescriptions because it prompts for the medication code, formulation, quantity, refills, syringe selection, directions/SIG, signature, and date.

Download Order Form

Ordering FAQ

Can a prescriber e-prescribe a compounded ED injection? +

Yes. Prescribers may e-prescribe when their EHR allows a compound, custom medication, miscellaneous medication, or free-text prescription entry. The prescription should include the Bayview formulation code when available, plus the full formulation, quantity, refills, syringe request if needed, and complete directions/SIG.

Do I still need the full formulation if I use a Bayview code? +

Yes. The code helps speed up identification, but the full formulation details should still be included so Bayview Pharmacy can verify the intended medication, strength, quantity, and directions before compounding.

What if the prescriber wants a custom strength? +

Bayview maintains a validated list of 64 ED injectable formulations. The 14 strengths printed on the order form are $100 per 2.5 mL multi-dose vial; every other validated strength is $150 per 2.5 mL multi-dose vial and is ordered on the CUSTOM line. Strengths outside the validated list may be prescribed when clinically appropriate, but they require additional pharmacist review and are priced case by case.

Can office staff call in the prescription? +

Prescribers or authorized office staff may call Bayview Pharmacy directly for prescription submission, clarification, titration questions, or refill coordination. Bayview Pharmacy can be reached at 401-284-4505.

What should the office do if the EHR will not accept the compound? +

Use the fax order form or call Bayview Pharmacy. The fax form is often the clearest option because it prompts for the formulation code, medication selection, quantity, refills, syringe selection, directions/SIG, signature, and date.

Direct Prescription Support

Call the Prescription Into the Pharmacy

Prescribers or authorized office staff may call Bayview Pharmacy directly for prescription submission, clarification, titration questions, or refill coordination.

Call 401-284-4505
Phone
401-284-4505
Fax
401-284-4506 Alternate fax: 401-210-2757
E-prescribe
Bayview Pharmacy Warwick, RI
NCPDP
4106882
Compounded Medication Disclosure

Compounded medications are prepared pursuant to a valid prescription for an individual patient and are not FDA-approved.