Despite the growing demand for compounded drugs, many insurance companies in Massachusetts are not covering the drugs in an effort to control costs, according to Mass Live.
Here are five key points:
1. Compounded drugs are created specifically by a pharmacy and are not available for consumers commercially, making it difficult for patients with legitimate medical needs to get the treatment. Many patients must pay out-of-pocket or find a different medication as a result.
2. Physicians often prescribe compounded medications because a patient may need a dosage that is higher or lower than usual or the patient may need a formulation such as a liquid instead of a pill. Compounded drugs are used in hormone replacement therapy, pain medication, dermatology, pediatrics and other fields.
3. In 2013, Harvard Pilgrim was the first insurer in the state to limits its coverage of compounded drugs for adults after the fungal meningitis outbreak. A Harvard Pilgrim spokesman claimed the insurer covers medically necessary drugs, but not cosmetic or dietary drugs.
4. Insurers are placing restrictions on compounded drugs as a way to control costs in the wake of rising healthcare costs and a trend toward greater use of compounded drugs. Payers began seeing a substantially increase in what they were paying to compounded pharmacists when the pharmacy industry enacted a system in which pharmacists tell insurers every ingredient in a compounded drug and its price as opposed to only the main ingredient.
5. Healthcare advocacy groups claim physicians should be able to write a prescription for the drugs they feel are necessary based on their patient's specific needs.
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