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540,000 Patients Lose Compounded Prescription Coverage says Patients and Physicians for Rx Access
Date:8/14/2014

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.

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