It’s a David vs. Goliath dispute and millions of patients are caught up in it — or not aware that they could lose coverage for the compounded medicines they need to treat their conditions.
The customized medication that pharmacists create for patients who are unable to metabolize or tolerate conventional drugs is at issue. Compounded medicines are often the only option for doctors who treat certain children or seniors, patients suffering from the effects of cancer or diabetes, as well as those with kidney and liver diseases.
One corner: Powerful insurance companies and pharmacy benefit mangers (PBMs), who are determined to save money by reducing or eliminating coverage for these medications.
On the other side, a coalition of patients physicians pharmacists and patient advocates is fighting to reverse their actions.
“This is about shifting costs to patients,”Jay McEniry, executive Director of(*) (Patients and Physicians for Rx Access saverxaccess.orgThe following is a list of “Physicians are being placed in the impossible position of either prescribing a compounded medication the patient needs but can’t afford, or prescribing a less effective treatment because it may be covered by the patient’s insurance.”
This includes Catamaran/United Healthcare/Optum Rx as well as CVS/Caremark and Harvard Pilgrim, Blue Cross Blue Shield plans across several states, and United Healthcare/Optum Rx.”Goliaths”However, the coalition is focusing its anger on the nation’s largest PBM Express Scripts. Express Scripts is slated to cease covering 1,000 common compounded medication ingredients in September.
says McEniry.”eliminating an entire class of medications,”Express Scripts and other companies argue that commercial drugs are just as effective for the same price. Try telling Linda Sauer that to her patients.
A Dwight woman in Illinois relies on compounded medications prescribed by her doctor for pain relief. Express Scripts’ decision to make her pay out-of-pocket for these medications leaves her furious.
She says.
“They’re denying me access to medicines that work better than the mass-produced drugs I’ve tried,”Sauer, at the very least, has read the advisory note from Express Scripts. This is what the coalition claims it gives. “It will cost me and others hundreds of dollars per month.”
For identifying what it calls “misleading reasons”Ingredients that are obtained from FDA-regulated suppliers. What about patients who did not?”essential medicines”Unfortunately, the next time they attempt to fill a prescription, they will be in for a surprise.
