Compounding pharmacists protest Express Scripts’ cuts

Compounding pharmacists are concerned about Express Scripts’ decision to stop covering around 1,000 active compounded drug ingredients used by compounding pharmacies to create topical treatments.

Starting this week, Express Scripts is blocking coverage for the ingredients, citing rising costs. Over the past two years, the pharmacy benefits manager (PBM) has seen the number and cost of prescriptions for compounded medicines used for treating scars, wrinkles, and pain rise dramatically, The Wall Street Journalreported.

In fact, the average cost for each prescription rose from $90 to $1,100, and for around 12 medications, the actual cost soared more than 1,000%. As a result, Express Scripts said the amount spent by its clients for compounded drugs increased to roughly $171 million in this year’s first quarter, up from $28 million during the comparable period in 2012.

“We are taking a bold step to eliminate compounds that either have many less-expensive, clinically-equivalent, FDA-approved options, or compounds that have no clinical evidence for their use whatsoever,” David Whitrap, director of corporate communications for Express Scripts, told Drug Topics.

“We will take these actions while ensuring there is a pathway for patients who clinically need specific compounds to get these compounds as covered by their plan. Our approach to compounds will lower the treatment costs for employers by 95%, affecting just 0.6% of our member population,” Whitrap added.

However, Express Scripts’ cuts are ultimately bad for pharmacists and patients, Jay McEniry, executive director of Patients and Physicians for Rx Access, a group recently launched by compounding pharmacies, told the Associated Press.

"This is the first time we've seen a systematic approach to substantially, effectively cut compounding coverage, which ultimately is very detrimental to patients," McEniry said.

Express Scripts’ cuts will take effect Sept. 15, unless customers specifically ask to continue paying for the compounded drugs. Companies that want to opt out of the cuts must notify the PBM by Thursday.

According to Whitrap, Express Scripts has an exception process in place that enables patients who truly have a clinical need for the ingredients to receive them. “We anticipate that those exceptions will be very rare, as we have focused our exclusions on compounds that have less-expensive, clinically-equivalent, FDA-approved alternatives commercially available, as well as on compounds that have no clinical evidence for their use,” he said.

Express Scripts is not the only insurer to cut out compounded medications, however. Recently, Optum Rx, the PBM that is part of United Health Group, CVS Caremark, and Catamaran have also started placing restrictions on coverage, The Wall Street Journal reported.