In one example recently highlighted by CBS Evening News, a compound pharmacy was able to successfully bill one of our competitors $44,707 for a one-month supply of compounded resveratrol, an antioxidant found in red grapes that can be purchased over the counter for $157.
June 22, 2015
Shutting Down Compounders’ Crushed Tablet Scheme
By tackling the problem of unethical compound pharmacies, Express Scripts is fighting for what is right on behalf of our clients.
Whether you’re a patient or a payer, the actions of certain compound pharmacies just don’t add up. They keep looking for loopholes that allow them to charge exorbitant amounts for compounded medications that are clinically unnecessary, even dangerous.
Reputable compound pharmacies exist to fill prescriptions that cannot be commercially manufactured, and we recommend that our clients to continue to cover legitimate compounds. For example, a patient who cannot swallow tablets may need them in a crushed or liquefied form. But instead of serving patients with special needs, some compounders look for ways togouge the U.S. healthcare system. They charge vastly inflated prices for compounded medications that do not provide any additional clinical value over more affordable FDA-approved alternatives that are already available.
We’ve seen compounding pharmacies try to charge hundreds or thousands of dollars per gram of bulk powder or cream. In one example recently highlighted by CBS Evening News, a compound pharmacy was able to successfully bill one of our competitors $44,707 for a one-month supply of compounded resveratrol, an antioxidant found in red grapes that can be purchased over the counter for $157.
At Express Scripts, we are continuously working to protect our clients and our members from these schemes. A year ago, we launched our Compound Management Solution, which blocks coverage for clinically unproven ingredients – primarily bulk powders – that go into these compounds.
When the Schemes Evolve, Our Solutions Adapt to Meet the Needs of Our Clients and Patients
But as we moved to close one loophole, entrepreneurial compounders identified another. Most recently, these pharmacies have been crushing massive numbers of tablets to add to a cream base, producing topical pain creams that are outrageously expensive. The creams are highly potent – and some patients who intentionally swallowed them ended up in the emergency room.
Today, we are announcing an expansion of our Compound Management Solution, to begin excluding the use of specific tablets and capsules.
One compounding pharmacy recently charged $24,000 for a cream made with 2,700 crushed tablets, and another compounder billed $12,000 for a cream containing 2,100 tablets. Consistent with our new protocols, Express Scripts will now reject both of those claims.
By tackling the problem of unethical compound pharmacies, Express Scripts is fighting for what is right on behalf of our clients. We estimate that as a result, our clients will save more than $1.9 billion this year, and that our new block on using crushed tablets and capsules will save our payers an additional $100 million each year.
