Compound medication prescribing hinders cost control efforts
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Although prescription drug formularies have been an industry mainstay at the payer level for years, state-adopted formularies can help with lingering obstacles to controlling medical costs such as compound medications.
“I think (states) did a great job of addressing the challenges that we have,” said Patricia Martin, Franklin, Tennessee-based assistant vice president of pharmacy programs with Gallagher Bassett Services Inc.
Compounds are packaged and sold at doctors’ offices and often at a premium. In some formularies such as California’s, regulators addressed compound medications, physician dispensing and repackaging of drugs, described as “pain points” for payers trying to manage medications that are either expensive but ineffective, or effective but not more so than a pain cream available over-the-counter at a pharmacy, according to Ms. Martin.
“It makes things a lot easier on my end” with state regulations prohibiting medications that payers and third-party administrators have been trying to avoid, she said. Gallagher Bassett had developed a program to manage compound medications, but some enforcement issues remained.
“When you now have a state come in and say ‘no’ … that gives us a lot of ability to manage those effectively,” she said.
”These things are topical pain creams in the thousands of dollars (sold by doctors),” said Craig Prince, a Thornton, Pennsylvania-based pharmacist working for Coventry Workers Comp. “And then you look at it and it’s Ben Gay plus capsaicin that you can buy at Walmart.”
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