The Latest Compounding Scheme: Crushed Tablets

Mar 5, 2015
A new trend among compound pharmacies increases the already staggering costs of compounded medications.
Tags
  • Compound Medications

Over the past year, news organizations have been reporting on the questionable tactics of certain compound pharmacies to gouge the U.S. healthcare system. Unfortunately, as regulators and payers have stepped in to curb this activity, these compounders have developed yet another way to game the system.

In efforts to remove much of the wasted healthcare spend going to these unnecessarily customized compounds, Express Scripts announced last June the launch of our Compound Management solution, which continuously monitors for clinically unproven ingredients – primarily bulk powders – that go into these compounds and blocks coverage for more than 1,000 of these ingredients. Our action will save our clients more than $1.9 billion in 2015.

But these compounders have countered with an enterprising way to circumvent the block on powders, and they have now shifted to crushing high quantities of commercially manufactured tablets into their creams. The compounders submit the claims for the on-formulary pills, plus the even more costly base creams, and the American public is left holding the outrageous bill for a topical ointment that offers no clinical improvement over much more affordable products already on the market.

Over the last half of 2014, the volume of tablets going into compounds has increased by 158%.

Terrifying Concoctions

Express Scripts has seen as much as 2,100 tablets submitted within one compound, where the compounding pharmacy was attempting to bill for over $41,000 and profit nearly $35,000 on one medication. With compounding pharmacies trying to get around the checks that Express Scripts has put in place, we are again taking steps to put in additional measures that limit this unethical activity.

Patient Safety Risk

Since compound medications are not regulated by the FDA, they can pose serious risks to patients and may not even be effective to treat the diagnosed condition. Furthermore, as these topical pain creams become increasingly potent, there are now reported cases of patients intentionally ingesting these creams orally and ending up in the emergency room.

Express Scripts Takes Action

We take a stand when nobody else does, which is why Express Scripts is committed to developing an even more comprehensive solution than our existing Compound Management solution.

This advanced offering will tackle these new loopholes that compounding pharmacies are using to unethically submit large quantities of tablets in compounded formulations and charging extreme amounts to insurers and payers.

We fight for what is right on behalf of our clients.

comments powered by Disqus