Michael Nguyen, Pharm.D., C.Ph., Director of Clinical Pharmacy
I’ve lost count how many times a claim manager asks if there is a less costly alternative to the compounded medication being requested. Each one of these requests is for a compounded topical pain cream and the submitted cost is often in the thousands. The answer to this question is not straightforward because we have to define what “alternative” typically means. In the most ideal case, an alternative to a drug such as Nexium would be omeprazole. Both drugs are a part of the same class of FDA approved medications with clinical trial data showing similar efficacy and safety. The main difference between these drugs is that Nexium is a brand-name, fandangle, more expensive version of omeprazole. In the case of compounded medications, the comparison is between apples and oranges. Compounds that are frequently created to treat pain are not FDA approved; therefore, an “alternative” would be any FDA approved drug that is indicated for the symptoms being targeted by the compound.
Excellent Points
I’ve lost count how many times a claim manager asks if there is a less costly alternative to the compounded medication being requested. Each one of these requests is for a compounded topical pain cream and the submitted cost is often in the thousands. The answer to this question is not straightforward because we have to define what “alternative” typically means. In the most ideal case, an alternative to a drug such as Nexium would be omeprazole. Both drugs are a part of the same class of FDA approved medications with clinical trial data showing similar efficacy and safety. The main difference between these drugs is that Nexium is a brand-name, fandangle, more expensive version of omeprazole. In the case of compounded medications, the comparison is between apples and oranges. Compounds that are frequently created to treat pain are not FDA approved; therefore, an “alternative” would be any FDA approved drug that is indicated for the symptoms being targeted by the compound.
Since these compounds are not FDA approved, their consideration for use must be based on therapeutic failure of FDA approved alternatives.
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