Com­pound drugs could ad­dress opi­oid abuse

Modern Healthcare - - NEWS - By Steven Ross John­son

Com­pound­ing phar­ma­cies say de­ci­sions by Ex­press Scripts and other phar­macy ben­e­fit man­agers to limit cov­er­age on cus­tom med­i­ca­tions could sti­fle health providers’ ef­forts to move to­ward less-ad­dic­tive al­ter­na­tives to opi­oid painkillers, the use of which many health ex­perts say has risen to epi­demic lev­els in the past decade.

The coun­try’s largest PBM an­nounced this month that it would drop cov­er­age of 1,000 drug in­gre­di­ents found in many com­pounded med­i­ca­tions be­gin­ning Sept. 15.

In an e-mailed state­ment, Ex­press Scripts spokesman David Whi­trap cited cost as the rea­son for the move, es­ti­mat­ing that it would lower treat­ment costs for em­ploy­ers on those med­i­ca­tions by 95% while af­fect­ing less than 1% of their pa­tient con­sumer base.

“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.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.