Pharmacy benefit managers (PBMs) and insurance companies are quietly cutting off payment for the majority of compounded medications physicians prescribe for their patients. Express Scripts (the nation’s largest PBM), United Healthcare, Optum RX, Blue Cross Blue Shield and Catamaran have already announced this denial of coverage, but this list will continue to grow. They have dropped coverage for the top 1,000 ingredients found in commonly-prescribed compounds. These cuts have either already gone into effect or will be effective as of September 15, 2014. Many patients may receive letters about this change, but they may also be notified at the pharmacy if their compound prescriptions are no longer covered. These actions will increase patients’ out-of-pocket costs and may also limit the physician’s ability to prescribe the best prescription medication for the patient.
Peoples has always been committed to effectiveness and excellence on our compounded medications. We conduct potency testing and beyond-use-dating (BUD) studies on many of our compounds to ensure effectiveness and stability. Our membership to Professional Compounding Centers of America (PCCA) enables us to use the latest information and highest quality ingredients for our compounds. For the last 30 years, we have been compounding medications for patients who have special needs and conditions such as chronic pain, sensitivities or allergies to additives (such as dyes, preservatives, lactose, gluten or sugar), hormone imbalances, infertility and children with developmental, functional or sensory issues. Peoples also offers unique delivery systems for patients who have difficulty swallowing, such as liquids, topical creams or gels, suppositories, sublingual troches, and lollipops. Compounded prescriptions are a small part of total health care costs, but they are vital for those patients with special needs.
One way patients can get involved to save their access to prescriptions is to go to Protect My Compounds. This site contains information on recent changes to insurance plans, how to speak with your human resources manager to keep coverage and protect access to compounded prescriptions, as well as a link to sign up to receive email alerts about the most recent developments in this ever-changing arena.
Save Rx Access is another option for patients interested in keeping their access to compounded medications. It is a coalition of people and organizations working to save patients’ access to compounded medications. This site has the most up-to-date information with support documents and resources on how to contact providers to request continued coverage.
As we move forward with these coverage changes, be assured that Peoples will work with every patient to make sure that this transition is as easy as possible and we will work towards a fair price solution for compounded medications.
by Deborah Fernandes, RPh.