FAIRHOPE, Ala.--(BUSINESS WIRE)--On May 11th, the Department of Defense (DoD) stripped active and retired uniformed service members and their families of coverage for many essential compounded medications. As much as 95% of all compounded preparations previously covered will be terminated. This decision was made without advance notice to the thousands of beneficiaries who are dependent on these medications and after numerous assurances from DoD officials that access to these medications would not be severely hindered for those who need it.
Myth: Compounded medications are not proven to be safe or effective.
Fact: Physicians prescribe compounded medications for patients who do not have a viable commercially available option. Patients sometimes cannot tolerate commercial medications due to certain ingredients, additives or excipients. Other times, the dosing amount or form is not appropriate. The preparation and dispensing of compounds is strictly regulated by both Federal and State law. The active ingredients in compounds are sourced from FDA-regulated suppliers, meet standards established by the United States Pharmacopeia, and, in many cases, are components of FDA-approved prescription drugs.
Myth: TRICARE can’t control the escalating costs of compounded medications.
Fact: Express Scripts, the pharmacy benefits manager hired to administer TRICARE’s pharmacy benefit, has numerous tools to manage the costs of medications without limiting patient access. A reasonable pricing mechanism or limited high-quality compounding pharmacy network are both options. Patient access to compounded medications has been lost simply because Express Scripts failed to appropriately manage this aspect of TRICARE’s pharmacy program.
Myth: Both the ingredient cost and the total cost of compounded medication prescriptions is simply too high.
Fact: In April, Express Scripts circulated a Price List to pharmacies that provide compounded medications to TRICARE beneficiaries. The Price List, which should have fully gone into effect on May 1st, and which both pharmacies and beneficiaries were told would go into effect on that date, would have substantially reduced the maximum allowable cost per ingredient used in compounded medications. Those lower ingredient costs would have resulted in overall reduced costs at the prescription level. However, Express Scripts only implemented that Price List for a small group of pharmacies rather than communicating and requiring it of the entire provider network. Additionally, Express Scripts continued to freely grant cost overrides for high dollar prescriptions, ignoring its own cost-control announcement. Consistent enforcement of a reasonable cap by Express Scripts would easily prevent prescriptions with exorbitant costs from being processed and paid by TRICARE.
This latest announcement is a complete about face from DoD. On numerous occasions, DoD officials are on record stating that compounded medications are “important” to TRICARE beneficiaries and a “majority” would continue to be covered under the program. In a May 14th DoD news article posted on their website, the Defense Health Agency’s chief of pharmacy operations stated: “Compounding pharmacies definitely have a role in medical care -- a very important role” as well as “…we’ll continue to make adjustments to ensure that we can provide access to legitimate compounds.”
Instead of calling Express Scripts to task for its long-term failure to oversee this part of the TRICARE pharmacy benefit, including its failure in implementing the promised May 1st pricing controls, the DoD is instead stripping beneficiaries of coverage for almost all compounded medications. Leaders within the DoD can ensure that beneficiaries who truly need compounded medications continue to get access by compelling Express Scripts to do its job by effectuating a cost savings program that doesn’t hinder patient access to these essential medications.
About Patients and Physicians for Rx Access
Patients and Physicians for Rx Access is a coalition consisting of individual patients, patient advocacy groups, pharmacists, physicians, pharmacies and healthcare organizations working to save patient access to compounded medications. The coalition formed to protect patients from the immediate threat from a growing number of pharmacy benefit managers and insurance companies who are working quietly to deny coverage for these essential medications. For more information visit http://saverxaccess.org/