One by one with pharmacy benefit managers the compensation for compounded drugs is going away. This time it’s Express Scripts that is sending letters to patients and doctors with a mid September cut off. Millions of patients benefit from compounded drugs. Most patients using compounded drugs don’t have an alternative, why they are using compounded drugs to begin with. So this is just great. Already in July Optum/United Healthcare stated that compounded drugs will need a prior authorization in some parts of the country so they are not gone there yet but could be denied.
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Over billing seems to be some of the reasons but in California, a compounded prescription can’t go over $600. Probably one of the most publicized cases with compounded drugs goes back to NECC in Massachusetts with contamination where several people died. That case was an extreme one and many compounded drugs are not used in IVs such as their products.
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This controversy focuses on drugs that are not IV and are more or less blended creams to treat pain, etc. The cost of the drugs supplied to compounders has risen also. There are some legitimate complaints here with expensive diaper rash products, etc. that can be bought in another fashion but what about the rest of the drugs? What are pharmacy benefit managers doing about expensive drugs that are not compounded too, and there’s a lot of those.
Many hormone replacement drugs are compounded to an specific mix for patients as well.
They should work on all of them as we are to the point to where drug companies and insurers need to work together as we are broke and there’s little the patient can pay any longer when it comes to expensive co-pays for high tiered drugs or those not covered at all. Express Scripts also laid off 400 people as many moved over to United Healthcare who has their own pharmacy benefit management company and moved patients over to their own subsidiary. BD
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FAIRHOPE, Ala., Aug. 14, 2014 /PRNewswire/ -- Express Scripts, the nation's largest pharmacy benefit manager, is offering ambiguous and misleading reasons for ending coverage of customized prescription medications for 540,000 individuals in order to conceal financial motives, a Patients and Physicians for Rx Access said Thursday, Aug. 14. The organization is fighting to stop the unprecedented benefit cuts being made by Express Scripts and other pharmacy benefit managers.
"In July Express Scripts began sending form letters to more than a half-million patients nationwide, saying it will stop paying for their compounded medications on September 15," said Jay McEniry, executive director of Patients and Physicians for Rx Access. "Patients are sharing those letters with us. The letters are filled with misleading statements designed to confuse these patients while denying them access to important medications prescribed by their doctor."
Some Express Scripts patients have received letters that fail to tell them their compounded prescription coverage is ending, instead describing the cutoff as a "clarification" of coverage. Those letters mention nothing of the mid-September cutoff date. Both versions of the letter instruct patients to replace their customized prescriptions with mass-produced, FDA-approved medicines, but warn that Express Scripts may not cover the new medications either.
In presentations regarding these benefit cuts, Express Scripts executives have told other audiences that the company's goal is to save hundreds of millions of dollars annually by ending coverage of essentially all compounded medicines before the end of 2014. When talking to patients, however, Express Scripts attempts to conceal its financial motives with misleading statements, McEniry said.