“We are taking a bold step to eliminate compounds that either have many less-expensive, clinically equivalent, FDA-approved options, or compounds that have no clinical evidence for their use whatsoever,” Whitrap wrote.
The St. Louis-based company is not the first PBM to restrict coverage on compounding pharmaceuticals. But with 90 million members, it is the largest PBM to limit compounding medication coverage. Compounding pharmacists contend such a move makes it more difficult to access drugs that provide an alternative when manufactured medications are not viable because of adverse health effects, or as in the case of opioid painkillers, increase the possibility of addiction in at-risk patients.
“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. While a powerful oral pain medication could be abused by a patient to use for non-medical reasons, converting a painkiller into a topical skin cream lowers the risk of abuse, Voliva said.
But PBMs 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 decision to restrict coverage.
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