United Heathcare Pharmacy Network Changes Coverage for Compounded Medications

Compounding Pharmacies Termed from UnitedHealthcare Pharmacy Network on Aug. 1

July 3, 2013

This notice only applies to UnitedHealthcare integrated commercial clients whose pharmacy benefit administration has not yet moved from Medco/ESI to OptumRx in 2013. It does not apply to UnitedHealthcare integrated commercial clients who have already moved from Medco/ESI to OptumRx in 2013, new pharmacy benefit business beginning in 2013, direct commercial business (OptumRx direct business without UnitedHealthcare medical coverage), non-HMO legacy PacifiCare, nor UnitedHealthcare public sector integrated commercial business that has been administered by OptumRx prior to Jan. 1, 2013.

 As described in the April editions of the Connection eNewsletters, UnitedHealthcare pharmacy has observed a rapid increase in the use of compounded medications that include non-FDA approved bulk chemicals. In addition, several network pharmacies have been identified by UnitedHealthcare as having unusual patterns of pricing and/or dispensing compound medications compared to other pharmacies in the network where these chemicals are being priced at a premium to current FDA-approved products on the market. 

As a result, on Aug. 1, 2013, eight pharmacies will be termed from the Medco/ESI pharmacy network based on their increased compounding of medications including those containing the bulk chemicals being excluded July 1 for UnitedHealthcare fully insured business. These pharmacies are not in the OptumRx/UnitedHealthcare pharmacy network. Approximately 600 members are impacted. 

Communications

• Impacted pharmaciesPharmacies being terminated were sent a letter in advance notifying them they will no longer be in the network. 
• Member notificationMembers who have filled at least one prescription at an impacted pharmacy within the past 90 days were sent a letter in advance of the pharmacy termination informing them the pharmacy will no longer be in the network and they will need to fill their prescription at a network pharmacy for coverage consideration. The letter also included instructions on how to transfer their prescription(s) to a new pharmacy. 

UnitedHealthcare will continue to monitor the practice of compounding at network pharmacies and keep you updated on other efforts to manage this concerning trend. For more information, please contact your UnitedHealthcare representative.

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