The St. Louis-based firm is not the first pharmacy benefits manager to restrict coverage on compounding pharmaceuticals. Last year OptumRx, the pharmacy benefits managing arm of insurer UnitedHealth Group dropped coverage for chemicals used in the compounding of vitamins and supplements typically sold over the counter, as well as cosmetic products and medications not approved by the Food and Drug Administration. In June, suburban Chicago-based pharmacy benefit manager Catamaran Corp. announced the launch of its Safe & Effective Compound Use Reassurance Effort (SECURE) as a means of helping its clients manage the rising cost of compounded medications. But with 90 million members, Express Scripts has raised the level of concern over such limits.
Compounding pharmacists contend that benefit managers are making it more difficult to get access to drugs that provide an alternative when manufactured medications are not viable because of adverse health effects, or, as in the case of opioid painkillers, because they increase the risk of addiction.
“Compounding offers a very unique, possible solution to opioid abuse in the United States,” said John Voliva, director of legislative relations for the Professional Compounding Centers of America, a leading trade group that represents nearly 4,000 independent pharmacists. “It wouldn't be the end-all, be-all solution, but I think it could be one of the tools that could be used and be used very well to help curb that abuse.”
Proponents say the idea of compounding for pain management has garnered increased interest from health practitioners in recent years. For example, while a powerful oral pain medication has the potential of being abused by a patient to use for non-medical reasons, converting a painkiller into a topical skin cream lowers the risk of abuse, Voliva explained.
But pharmacy benefit managers have cited the rising costs and use of compounding medications, as well as concerns over the safety and efficacy of these types of drugs, as reasons for their moves to restrict coverage.
In a press release to announce its SECURE program, Catamaran cited a five-fold increase in its annual expenses for compounded medications among its commercial clients. Likewise, OptumRx has said that it saw compounded drug use increase among its members by 35% over a 12-month period between 2012 and 2013.
As a whole, the compounding pharmacy industry has seen annual growth at an estimated rate of 1.5% from 2009 to 2014, according to a report conducted by financial analyst, IBISWorld, which projected the sector would grow by 3.5% a year from 2015 to 2019, for revenues totaling $6.2 billion. Such an increase will be spurred by an expected rise in physician visits as more Americans receive health coverage through the Patient Protection and Affordable Care Act.
Calls for more pain management alternatives have been growing more urgent in recent years in the wake of a stark rise in opioid use over the last decade. According to a report by the Centers for Disease Control and Prevention, the number of prescription painkiller overdose deaths increased from 4,000 in 1999 to nearly 15,000 by 2008.
An estimated 12 million Americans above the age of 12 reported using prescription painkillers for nonmedical use in 2010, costing insurers an estimated $72 billion a year in medical expenses, the CDC report stated.
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