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It could just be that item mods in general change item generation, but idk.
basically there are 13 different pill colors and at the start of a run random effects are assigned to each color, there are horse pill variants of each color that activate a more potent effect.
If they've updated the API to allow custom horse effects to be created then I would imagine it works just fine, unless you're referring to custom pill colors, but I'm not sure if that's a thing.
However, some custom pills are simply cards(such as the Daily Dose) and would have to have an exception created for them, which I am not going to go out of my way to do.
if you dont have them unlocked and dont want to feel like youre cheating the game then just wait until after unlocking them to subscribe
humbling bundle is also an item, plus some effects of horse pills are pretty powerful