Comp leaders warn against misuse of drug compounding

Workers compensation leaders say the common practice of compounding medications for injured workers can be costly and dangerous if not done appropriately and is not guided by regulation, according to a paper released Monday by CompPharma, L.L.C. 

CompPharma, a consortium of workers compensation pharmacy benefit managers, analyzed compounding for its paper “Compounds in Comp: A New Look at Patient Safety, Efficacy and Cost” to “clear up confusion surrounding compounding medications in workers’ compensation. It clarifies research on the efficacy of compounds and explores how a pricing benchmark that was never intended to be applied to pharmaceutical grade chemicals has been manipulated to drive compounding prices and profits,” according to the text. 

In it, authors wrote they support traditional compounding, which FDA defines as “the extemporaneous combining, mixing or altering of ingredients by a pharmacist in response to a physician’s prescription to create a medication tailored to the specialized needs of an individual patient.” 

Yet much compounding in workers’ compensation involves creating a compounded product, marketing it to prescribers and billing “exorbitant prices,” according to the authors. The paper also shows how the average wholesale price benchmark — the universal benchmark for prescription drug reimbursement in the United States today — has been manipulated to “drastically inflate compound prices and outlines state legislative and regulatory controls.” It is also a practice that can be wrought with fraud, according to the authors.

Not only is cost an issue but so is safety, according to lead author Phil Walls, Tampa, Florida-based chief clinical officer for pharmacy benefit manager Matrix Healthcare Services Inc., which does business as myMatrixx.

“Exposure to high concentrations of local anesthetics found in some compounded creams can cause seizures and irregular heartbeats, and there have been deaths associated with their use,” he said in a statement.