Navigation Links
540,000 Patients Lose Compounded Prescription Coverage says Patients and Physicians for Rx Access

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."  

In most letters, Express Scripts states that it will end coverage in September because the patient's medication contains at least one ingredient that has not been verified as safe and effective by the federal Food and Drug Administration. However, Express Scripts fails to mention that the FDA verification process is generally reserved for testing mass-produced drugs made by large manufacturers. The FDA process is not applied to compounded prescriptions because pharmacists custom make the medications based on a doctor's order to meet the unique needs of each individual patient.

Numerous state and federal laws and regulations are aimed at ensuring the safety and efficacy of compounded medications. For example, pharmacists are required to purchase ingredients used in compounded medications from FDA-regulated suppliers, who also supply ingredients to many commercial drug manufacturers.

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.

"By arbitrarily eliminating an entire class of medications, Express Scripts is unfairly limiting physician and patient options," McEniry noted. "Express Scripts is placing the physician in the impossible position of either prescribing a medication that the patient needs but can't afford, or prescribing a less effective treatment because it may be covered by the patient's insurance. Express Scripts is effectively hijacking the physician-patient relationship."

Linda Sauer of Dwight, Ill., one of the 540,000 patients affected by the Express Scripts decision, said she is taking her story to social media to tell others what the company is doing. Sauer has several painful and debilitating conditions that are treated with customized prescription medications.

"Express Scripts is denying me access to medicines that work better than the mass-produced drugs I've tried," Sauer said. "It's not fair to suddenly refuse to pay for medications that patients have relied upon for years in some cases, just to pad the company's bottom line. Express Scripts' decision will cost me hundreds of dollars per month, and I'm just one of many who are affected."

In addition to Express Scripts, other companies that have announced or recently implemented plans to eliminate or severely limit coverage of compounded medicines include United Healthcare/Optum Rx, CVS/Caremark, Catamaran, Harvard Pilgrim and some Blue Cross Blue Shield organizations. The Federal Trade Commission has estimated that 95 percent of all individuals who have a prescription benefit receive their coverage through a pharmacy benefit manager.

The move to eliminate coverage for an entire category of medicines is unprecedented; instead, pharmacy benefit managers typically use numerous mechanisms at their disposal to manage the cost of medications. Furthermore, the latest cuts are being made despite numerous studies that indicate compounded medications meet an important medical need.

Physicians prescribe customized medications to an increasing number of patients for a variety of reasons. Compounded medications are prescribed for patients who are allergic to dyes, glutens and other ingredients found in mass-produced medications. Another major use of compounded medications is to treat patients with persistent pain who need to avoid the side effects of potentially addictive opioid pain medications.

Other patients rely on customized medications to treat the symptoms of cancer and diabetes, to help heal wounds, and to address hormonal imbalances and other conditions that have not responded well to commercially made drugs.

Express Scripts reportedly covers as many as 90 million people; the company says its cutbacks will affect "only 0.6 percent" of its patients, which equals 540,000 individuals. This elimination of benefits effectively impacts all 90 million Express Scripts patients by shutting off access to essential medicines they may need in the future.

About Patients and Physicians for Rx Access
Patients and Physicians for Rx Access is a coalition consisting of individual patients, patient advocacy groups, pharmacists, physicians, pharmacies and healthcare organizations focused on raising awareness about compounded prescription access. The coalition formed to protect patients from the immediate threat from a growing number of pharmacy benefit management firms and insurers who are working quietly to deny coverage for the vast majority of compounded medicines.

SOURCE Patients and Physicians for Rx Access
Copyright©2014 PR Newswire.
All rights reserved

Related medicine technology :

1. Study Showed Patients Treated With The miraDry© System Experienced 82 Percent Sweat Reduction On Average
2. Argos Therapeutics Secures $25 million Series D Financing to Commence Phase 3 ADAPT Study in Patients with Metastatic Renal Cell Carcinoma (mRCC) in Mid-2012
3. Phreesia identifies over 26% of patients who require additional autism evaluation
4. Onyx Pharmaceuticals Announces FDA Advisory Committee to Review Carfilzomib for the Treatment of Patients with Relapsed and Refractory Multiple Myeloma
5. New post-hoc analyses examined Neupro® effects on pain, depressed mood, apathy and fatigue in patients with Parkinsons disease
6. Patient Advocate Foundation Announces New Co-Pay Relief (CPR) Offerings for Patients Facing Health Issues Due to Electrolyte Imbalance
7. Retrospective Study Suggests that Stereotactic Ablative Radiotherapy (SABR) Can be a Viable Option for Treating Early-Stage Lung Cancer in Operable as well as Inoperable Patients; Phase III Randomized Trial Now Under Way
8. Endocrinology Market to 2018 - Advanced Injection Devices for Growth Hormone and Somatostatin will Improve Ease of Use for Patients
9. Boehringer Ingelheim Announces Launch of GLORIA™-AF Registry in Newly-Diagnosed Patients with Non-Valvular Atrial Fibrillation
10. Study Results Demonstrate Analytical Treatment Interruption to Assess Antiviral Activity of Argoss Arcelis™ Personalized Immunotherapy for Treatment of HIV Patients, AGS-004, Is Acceptable Strategy for At Least 16 Weeks
11. CSL Behring Initiates Study of Subcutaneous Administration of C1-esterase Inhibitor in Patients with Hereditary Angioedema
Post Your Comments:
(Date:11/30/2015)... KONG, Nov. 30, 2015 (HK$,000)For the Six Months Ended 30 September 2015 ... Income , 421,979 , 384,242 , ... , 34,719 , (18.3) Medical Insurance ... , 16.1 Medical Devices and Accessories Sales , ... Chinese Herbal Medicines Sales , 2,822 , ...
(Date:11/30/2015)... Calif. , Nov. 30, 2015 /PRNewswire/ ... the norm in U.S. medical imaging is ... increasingly popular accountable care payer-provider contracts are ... and, in their wake, alter provider-vendor relationships. ... payments will push forward new purchasing frameworks ...
(Date:11/30/2015)... Nov. 30, 2015 Oramed Pharmaceuticals Inc. (NASDAQ: ... the development of oral drug delivery systems, announced today ... at up to $50,000,000 with Hefei Tianhui Incubator of Technologies Co., Ltd. ... capsule, ORMD-0801, in China , ... . The agreements were signed at the Israel ...
Breaking Medicine Technology:
(Date:11/30/2015)... ... November 30, 2015 , ... HemoTreat™ has announced that the ... ointment to its website. , “Our goal is simple:” says Michael Blasco, HemoTreat’s ... the comparison chart and ingredient list allows our customers to quickly see why, ...
(Date:11/30/2015)... ... November 30, 2015 , ... ... by athletic teams looking to maximize recovery through quality sleep. Tim DiFrancesco, training ... consistently get a better night’s sleep. ChiliPad precisely regulates the surface temperature of ...
(Date:11/30/2015)... Plains, NJ (PRWEB) , ... November 30, 2015 ... ... their top choice for innovative, patient centered orthopedic care. Led by John ... of your injury or chronic condition, the team at Advocare Orthopedic & Sports ...
(Date:11/30/2015)... ... 30, 2015 , ... Dr. Seth D. Margulies specializes in orthodontics and is ... Margulies to experience the best available orthodontic experience in the area. Dr. Margulies ... , Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention, and ...
(Date:11/30/2015)... , ... November 30, 2015 , ... Newly reviewed and ... His grandfather graduated from Tufts School of Dental Medicine in 1935. His father ... the Isola family being in dentistry as well as their commitment and passion to ...
Breaking Medicine News(10 mins):