Compound Coverage grows increasingly complex

If gas or home price increases outpaced inflation by almost 130 times, there would be outrage. For compound medicines, it’s reality. And someone has to pay this massive expense.

Plan sponsors are seeing dramatic increases in the use and cost of compound medicines (combinations of drugs or bulk chemicals combined to create a product that isn’t commercially available). Compound drugs may be unique, but they’re not uncommon — they make up 1 to 3 percent of all pharmaceuticals. And they’re incredibly expensive; costs for payers have increased 218 percent, on average, year-over-year, for the last two years.

Compound drug prices have surged 218 percent, on average,

year-over-year for the last two years.[1]

Challenges for plan sponsors

For plan sponsors, compound medicines present several challenges, with cost at the forefront.

Wholesale prices and shortages have led to very high prices

With a lack of Food and Drug Administration (FDA) approval and warnings, there are strong safety concerns

  • Benefit design issues have emerged with these drugs’ unique nature and billing
  • Strategies for managing compound drugs
  • The right strategies can help control the risks and costs associated with compound drugs and support your employees’ access to safe, affordable medicines.

Prime and your Blue Plan are implementing several strategies, such as revising the steps taken as part of the pharmacy audit process. As an employer, one of the most important strategies you can use is drug exclusions. Drug exclusions limit or remove non-preferred drugs from your drug list to encourage appropriate medicine prescribing and use.

Please contact your Prime representative to learn more about managing compound drugs.


[1] Solid Benefit Guidance. (2014, July 24). Rising cost of prescription compounds. Retrieved from http://sbgbenefits.com/knowledge-center/rising-cost-of-prescription-compounds/

 

 

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