The latest, and perhaps, the most drastic response comes from Express Scripts ESRX -0.38%, which this week will begin blocking coverage for approximately 1,000 active ingredients – an assortment of ointments, creams and powders – that are widely used by compounding pharmacies to create countless topical treatments, an Express Scripts executive tells Pharmalot.
Over the past two years, Express Scripts has seen the number and cost of prescriptions for compounded medicines used for treating scars, wrinkles and pain rise dramatically.
For instance, the average cost for each prescription rose to $1,100 from $90, and for about a dozen such medications, the actual cost jumped by more than 1,000%. Consequently, 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.
“It’s an issue of waste,” says Glen Stettin, senior vice president for clinical, research and new solutions. “For nearly all of these products, there’s already a commercial preparation already available – a generic or brand-name product approved by FDA. And there is no evidence to support their use at all.”
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4 comments:
On July 7, 2014, my Pharmacist asked payment to Express Scripts for my prescripton of Gabapentin. I take 4,800 mg. in 5 divided doses daily. It is for rheumatoid arthritis pain, osteoarthritis pain, diabetic neuropathy pain, pain from muscle and head injuries, diplopia, and seizure prevention. Express Scrips denied my doctor's prior authorization, July 10, Express Scripts denied the appeal. I ran out July 11. I went into severe withdrawal symptoms. By Mnnday, July 14, I had an appointment with the doctor (Neruo-opthmalogist). I was shaking out of control. My congnitive abilty was overwhelmed by any stimulus. My doctor put me back on Gabapentin in tablet form. He weighted my continuing to withdraw and dying, with a form of the drug I was very hypersensitve to. I am very hypersensitive to corn and FD&C food coloring. After a week, I am beginning to stablize, but I am reacting to the corn and FD&C coloring. Express Scripts is lying to the employers and employees. They have no intention of making an exception to employees/retirees who require compounded medications because they have no alternatives. I have contacted Texas Dept. of Insurance, but have little faith they will help me. I sent in documentation to them yesterday, July 22. When I got home, I found a notice in the mail that they were excluding from payment, Doxycycline. I take normally, 11 compounded prescriptions. Two are antihistamines, two are blood pressure drugs, one prevents severe earaches, one is to stop and keep stopped fungus on my hands, and four are for complications of a form of gangrene. Without these drugs, I will die. That appears to be a positive result for Express Scripts. If I am dead, I won't cost them anything. All tablets use cornstarch. I am very hypersensitive to cornstarch. All capsules used commercially by drug companies are made by Lilly with sodium lauryl sulfate. I am extremely hypersensitive to sulfates. My health is very fragile in the first place. Refusing to pay from most of my drugs will kill me. Both my husband and I are disabled and barely able to cover copayments as it is. We don't have the resources to pay out of the pocket for these 11 esential medications. Add to that, Express Scripts is not approving enough medication to taper off drugs that can not be stopped abruptly. I have four that must be tapered if stopped: Gabapetin, Methylprednisone, Clonidine, and Lantus. BTW, when Express Scripts refused payment on the Gabapentin, they did not give me ANY notice, Gabapentin powder is still in the plan preferred list. There is nothing in their website for patients, nor on Texas A&M University System's website announcing or news or whatever indicating that our drug insurance would refuse to pay for compounded drugs. Nor is Express Scripts allowing any exceptions for critical medications. When I found this in the news, the stories said there were a 1,000 compound drug ingredients involved. I have not been able to find out which ingredients they are axing. Without these drugs, I will die and probably before the end of the summer.
According to their website you can determine what your plan covers (and what API is excluded) at Express Scripts, by logging into www.express-scripts.com. If you don’t already have an account, you can create an account this will allow you to view your formulary and what is covered.
In 2000 when we first went on Medco, I was assured I would continue to be able to take the medications I needed. When Medico merged with Express Scripts,I still was reassured I would still be able to obtain the medications I needed.I had not take cost and greed into considerationf=of serviceg. With this press release they apparently succeded to deranchies the French.as the NWEIXNtribes are aware.
TAMUS has self insured their benefits package and they use Express Scripts/Medico to administer the drug benefit. As in tradeoffs, I was hospitalized within a few days of being cut off from the Gabapentin. I not only had tried all the suggestions from Anon. I looked through TAMUS websites and more. I knew from previous years how TAMUS setup their websites.
After 2 hospital stays, and roughly around four of out patient therapy, I was having problems finding time to counter the claims by Express Scripts and the lies of one staff member.
Finally, I have dicussed this with the manager over Employee benefits. She already knew my case history due to problems with other insurance. She managed to have an over ride for all my compounded medications through Sep 27, 2015. Basically, we are procrastating and wil wait until things setal down. At that time I'll have to have alternatives ready or different approaches. So basically, we won the battle but we lost the war.
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