Friday, December 19, 2014
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

Express Scripts cuts payments for customized drugs

By
From page B6 | July 04, 2014 |

WASHINGTON — The nation’s largest pharmacy benefit manager, Express Scripts, is dramatically scaling back its coverage of compounded medications, saying most of the custom-mixed medicines are ineffective or overpriced.

The company, which manages prescriptions for 90 million Americans, plans to drop coverage for 1,000 drug ingredients commonly found in compounded medications. Express Scripts executives say the move is a cost-saver for employers that will reduce their spending on compounded prescriptions by 95 percent.

“What we are eliminating is, pure and simple, wasteful spending,” said Senior Vice President Glen Stettin, in an interview with The Associated Press. “These drugs are being used when there are other things available that are already approved by the FDA and are less expensive.”

But the coverage change has prompted a swift pushback from compounding pharmacists, who argue that such cuts deprive patients of crucial medications that are not available as manufactured drugs. A compounding pharmacy industry spokesman said similar efforts to curb coverage are in the works from several insurers and pharmacy benefit providers, including UnitedHealthcare and some Blue Cross Blue Shield plans.

“This is the first time we’ve seen a systematic approach to substantially, effectively cut compounding coverage, which ultimately is very detrimental to patients,” said Jay McEniry, executive director of Patients and Physicians for Rx Access, a group recently launched by compounding pharmacies.

The cuts by Express Scripts will take effect Sept. 15, unless customers specifically ask to continue paying for the compounded drugs. Companies who want to opt out of the cuts must notify Express Scripts by Thursday.

Express Scripts, CVS Caremark and other pharmacy benefit managers are paid by employers to manage pharmacy costs. They do this by negotiating discounts and rebates from drugmakers and wholesalers, and by setting up tiered drug lists that steer patients toward lower-cost drugs, which are often generics.

In recent years pharmacy benefit companies have focused their cost-saving efforts on new specialty drugs like Sovaldi, a hepatitis C treatment from Gilead Sciences that costs about $1,000 per pill. Express Scripts reported earlier this year that specialty drugs accounted for more than a quarter of all U.S. drug spending, even though they total less than 1 percent of prescriptions. Compounded drugs occupy a different niche in the pharmaceutical landscape.

Compounded medicines are custom-mixed by pharmacists to meet the prescribing instructions provided by a doctor. For instance, if a patient is unable to swallow a pill their doctor may order a liquid formulation of the same drug from a compounding pharmacy.

Express Scripts says patients will still be able to get necessary compounded medicines under its plan. Instead, the company’s cuts focus on untested topical creams and ointments used to treat pain and other conditions. For example, Express Scripts says some compounding pharmacies will mix five or more drugs into a pain cream even though there’s no evidence that the combination is better than a single-ingredient drug. And in many cases that single ingredient is already available as an over-the-counter drug or a conventional prescription.

“Your health benefit is intended to pay for things that have demonstrated efficacy. These are things that wouldn’t pass muster,” said Express Scripts’ Stettin, who heads the company’s clinical research division. He estimates less than a half-percent of patients who get prescriptions through the St. Louis-based company will be affected by the coverage changes.

Along with questionable effectiveness, Stettin says prices for many compounding drugs have risen to unjustifiably high levels. Between the first quarter of 2012 and the first quarter of 2014, Express Scripts says its spending on compounded medications increased nearly 370 percent to $131 million. The average cost of a compounded medicine rose more than tenfold in that period: from $90 to $1,100 per prescription. While some of that increase is due to doctors writing more prescriptions, Express Scripts says the bulk is due to inflation of drug ingredient prices by manufacturers.

Over the last two years, Express Scripts has recorded increases of 100 percent or more in the average price of 117 compounding ingredients. Among that group, 13 ingredients have seen price increases of over 1,000 percent.

In a written statement Wednesday, the compounding coalition said that pharmacies do not control drug ingredient prices. The group also noted that pharmacy benefit managers like Express Scripts can set caps on what they are willing to pay for various medications.

“Express Scripts should explain why it has chosen not to set ‘maximum allowable pricing’ across the board, rather than attempting to shift responsibility to pharmacists and shift costs to its customers,” the group said.

Express Scripts Holding Co. is based in St. Louis.

 

The Associated Press

The Associated Press

LEAVE A COMMENT

Discussion | No comments

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

.

Solano News

 
Sondheim’s ‘Woods’ holiday showcase for Missouri Street Theatre

By Amy Maginnis-Honey | From Page: B1 | Gallery

 
Groundbreakings, ribbon-cuttings play role in civic life

By Barry Eberling | From Page: A1, 1 Comment | Gallery

Frankye Kelly ready to spread holiday cheer

By Amy Maginnis-Honey | From Page: B1

 
Celebrate the magic of Christmas

By Tony Wade | From Page: A2, 2 Comments

 
Santas have busy week at schools

By Susan Hiland | From Page: A3, 1 Comment

 
Safe streets task force work nets 3

By Ryan McCarthy | From Page: A3, 4 Comments

 
 
Solano College approves officers, meeting schedule

By Susan Winlow | From Page: A4

Longtime Suisun harbor master to retire

By Ian Thompson | From Page: A4, 2 Comments

 
 
Fairfield police log: Dec. 17, 2014

By Susan Hiland | From Page: A12

 
Suisun City police log: Dec. 17, 2014

By Susan Hiland | From Page: A12, 1 Comment

 
.

US / World

Hope and some fear in Cuba amid thaw with US

By The Associated Press | From Page: A1

 
Next steps on Cuba: Normalizing could take awhile

By The Associated Press | From Page: A1

Sony hacking fallout puts all companies on alert

By The Associated Press | From Page: A1

 
Sony film took aim at North Korea’s biggest taboo

By The Associated Press | From Page: A1, 4 Comments

Timeline of the Sony Pictures Entertainment hack

By The Associated Press | From Page: A1

 
Digital dilemma: How will US respond to Sony hack?

By The Associated Press | From Page: A1

 
Spy’s parents search for son after Cuba-US deal

By The Associated Press | From Page: A1

 
Local emergencies in Northern California counties after rain

By The Associated Press | From Page: A5

California’s top utility regulator defends record

By The Associated Press | From Page: A5

 
‘Pretty horrible’ scene; car slams into crowd

By The Associated Press | From Page: A5

 
Police: Drunk man shot while entering wrong house

By The Associated Press | From Page: A5, 4 Comments

Tsarnaev appears in court for 1st time since 2013

By The Associated Press | From Page: A6

 
President signs legislation ending Nazi benefit checks

By The Associated Press | From Page: A7

2 states challenge Colorado marijuana legalization

By The Associated Press | From Page: A8, 3 Comments

 
‘Prison Houdini’ set to make his 1st legal escape

By The Associated Press | From Page: A8

Top Islamic militants killed; more US troops going to Iraq

By The Associated Press | From Page: A8

 
Feds sue NYC over Rikers Island jail violence

By The Associated Press | From Page: A8

Russian sailors leaving France without warship

By The Associated Press | From Page: A9, 1 Comment

 
Putin: West wants to defang, declaw Russian bear

By The Associated Press | From Page: A10

Suspected Islamic extremists kidnap 185 in Nigeria

By The Associated Press | From Page: A13, 2 Comments

 
European court rules obesity can be a disability

By The Associated Press | From Page: A13

.

Opinion

Editorial Cartoon: Dec. 19, 2014

By Daily Republic Syndicated Content | From Page: A11

 
News of the day strikes a chord

By Bud Stevenson | From Page: A11, 10 Comments

 
Another look at school bonds

By George Guynn Jr. | From Page: A11, 4 Comments

 
.

Living

Today in History: Dec. 19, 2014

By The Associated Press | From Page: A2, 1 Comment

 
Community Calendar: Dec. 19, 2014

By Susan Hiland | From Page: A2

Horoscopes: Dec. 19, 2014

By Holiday Mathis | From Page: D8

 
Should I use Child Protective Services threat to get back rent?

By Kathy Mitchell and Marcy Sugar | From Page: D8

.

Entertainment

Week in preview Dec. 19-25, 2014

By Amy Maginnis-Honey | From Page: B1

 
Sweet ‘Night at the Museum’ bids farewell to Robin Williams

By The Associated Press | From Page: B2

 
Craig Ferguson to end 10 years as host of ‘Late Late Show’

By The Associated Press | From Page: B3

Eric Idle brings ‘Not the Messiah’ to Carnegie Hall

By The Associated Press | From Page: B3

 
Entertainment calendar Dec. 19, 2014

By Susan Hiland | From Page: B4

.

Sports

A’s trade All-Star catcher Derek Norris to Padres

By The Associated Press | From Page: B7

 
Warriors beat Thunder 114-109 after Durant injury

By The Associated Press | From Page: B7

 
A’s acquire lefty De La Rosa from Arizona for cash

By The Associated Press | From Page: B7

Raiders defense depleted by injuries

By The Associated Press | From Page: B7

 
49ers’ Harbaugh mum on reported offer from Michigan

By The Associated Press | From Page: B7

49ers’ Aldon Smith hopes to build off tough year

By The Associated Press | From Page: B7

 
Rivera: Newton ‘probably’ will start vs. Browns

By The Associated Press | From Page: B8

Bears bench QB Jay Cutler for Clausen

By The Associated Press | From Page: B8

 
‘Hands Up’ players to attend Ferguson Christmas party

By The Associated Press | From Page: B8

Celtics trade Rondo to Mavericks

By The Associated Press | From Page: B8

 
Rodriguez boys open Les Curry Tournament with victory

By Daily Republic staff | From Page: B8

39 bowl games and a reason to watch every one

By The Associated Press | From Page: B8

 
Column: Thaw in US-Cuba relations warms up MLB

By Jim Litke | From Page: B8

Signups for Friday, Dec. 19, 2014

By Paul Farmer | From Page: B9

 
This date in sports history for Friday, Dec. 19, 2014

By The Associated Press | From Page: B11

Sports on TV/Local sports for Friday, Dec. 19, 2014

By Paul Farmer | From Page: B11

 
.

Business

Roomiest Subaru Legacy debuts for 2015

By Ann M. Job | From Page: C1

 
Dow industrials have their best day in three years

By The Associated Press | From Page: B6

Ford expands drivers air bag recall nationwide

By The Associated Press | From Page: B6

 
Constantly changing online prices stump shoppers

By The Associated Press | From Page: B6

.

Obituaries

Lisa Dee McHughes

By Nancy Green | From Page: A4, 1 Comment

 
Dominic C. Scolaro

By Nancy Green | From Page: A4

Ernest “Ernie” Moretti

By Nancy Green | From Page: A4

 
Travis Curt Price

By Susan Hiland | From Page: A4, 1 Comment

Jennie Ponce Reyes

By Nancy Green | From Page: A4

 
Patricia “Pat” Anne Stringfield-Pierre

By Nancy Green | From Page: A4

.

Comics