What pain physicians should know about compounding: 3 Qs with a pharmaceutical CEO

Shital Parikh Mars, CEO of the prescription and compounded medications provider PharmCo RX, cut through the noise on the opioid epidemic and alternative therapies, telling Becker's ASC Review what pain physicians really need to know.

Question: When you talk to pain physicians about the opioid epidemic and alternative therapies, what's one thing they're surprised to hear? What insights can you share that they haven't heard before?

SM: The first thing doctors are surprised to hear is that compounds do not have to be expensive. There was a time when the word compound meant a prescription costing $10,000 or more, but those prescriptions are not common today. Today, suitable compounds for pain can be made for as little as $50 to the patient and as much as $3,000 to $4,000 for a 30-day supply. Since everything we do is custom, it depends on what [the] ingredients are. Some insurance companies cover compounds, some don't. We do our best to work with the doctor and the patient to get him/her a medication that is cost-effective.

Compounds can be more effective at treating pain than an opioid. There are even cases where certain combinations of [over-the-counter] pain treatments are more effective than opioids. The reason for this is because compounds are designed to treat localized pain symptoms and the exact type of pain the patient is experiencing. They also can have less side effects and cause less systemic damage than opioids. Opioids are not a catch-all pain treatment.

Not all compounds are created equally. A compound made from PharmCo will look and feel differently from a compound made by another pharmacy. We only used FDA-approved medications. Doctors are often wary of compounds because they are not sure what the pharmacy could put in the medication. At PharmCo, we provide the doctor with a full worksheet, showing what medications were ordered by the doctor and in what concentrations, so they can have confidence that there are no other additives that they did not approve.

Q: What are ways physicians at surgery centers and independent practices can successfully reduce opioid use without risking patient safety, satisfaction and outcomes?

SM: Physicians have to stay up to date on current pharmacology or work with a good pharmacy to provide necessary consultation. There are dozens of drugs that are effective at treating pain that are non-habit forming. The right combination of medications can mean restoration of functionality and a more fulfilling lifestyle for the patient. They should consider these options before prescribing an opioid. In many cases post-surgery, an opioid can be prescribed in low doses for immediate postsurgical care and then the patient can transition to these other medications for the longer duration of recovery.

It's [also] important to recognize that pain has to be adequately managed. We turn to opioids because they conveniently resolve a pain issue in the short-term sense. However, they come with a lot of side effects and hazards. But without adequate pain management, patients will suffer. Suffering patients will turn to borrowed medications from friends and relatives, try untested and unverified therapies, and even look for relief from illicit substances. So, it's important for physicians and pharmacies alike to get it right for the patient so that [they] can have adequate relief without prolonged harmful effects.

Q: How does Progressive Care persuade insurers to cover alternative therapies? What strategies do you use?

SM: There is very little we can do to persuade an insurer to cover a non-formulary medication. However, detailed notes, diagnosis codes, and examples of failed alternatives helps. We have been successful in getting formulary exceptions when the patient cannot take oral NSAIDs due to ulcers or deteriorated kidney or liver function and where the patient has tried standard treatment methods with limited or no success. We can spend hours on the phone with a carrier going through a patient's history to show that the only medication that has been successful at managing the patient's pain is a compound we have made.

We understand there is skepticism about compounds; however, we believe there are simple ways of monitoring effectiveness and conducting administration on the insurance plan side. We think insurance companies need to re-evaluate how they run their formularies to include compounds for the benefit of their patient base and help fight the opioid crisis. 

To participate in future Becker's Q&As, contact Angie Stewart at astewart@beckershealthcare.com. For a deeper dive into ASC industry trends, attend the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC in Chicago, June 13-15, 2019. Click here to learn more and register.

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