Wednesday, August 27, 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

Walnut Grove shows a bit of historic Japan

By Susan Winlow | From Page: A1 | Gallery

 
Walnut Grove: Fun facts, things to see

By Susan Winlow | From Page: A1, 1 Comment

Ryde Hotel: A speakeasy from the past

By Susan Winlow | From Page: A1, 2 Comments | Gallery

 
Solano County supervisors get raise

By Barry Eberling | From Page: A2, 13 Comments

Weather for Aug. 27, 2014

By Daily Republic | From Page: B3

 
Solano helps after Napa quake

By Barry Eberling | From Page: A3 | Gallery

Solano supervisors declare quake state of emergency

By Barry Eberling | From Page: A3

 
 
Solano promotes hand washing

By Barry Eberling | From Page: A5, 2 Comments

 
Golf tournament to benefit college sport’s teams

By Susan Winlow | From Page: A6

 
Man steals car from Fairfield resident

By Barry Eberling | From Page: A6, 6 Comments

 
Learn about local travel opportunities

By Amy Maginnis-Honey | From Page: A6

Solano College to host college transfer fair

By Susan Winlow | From Page: A6

 
Pierce Brosnan thriller kicks off week’s new films

By Amy Maginnis-Honey | From Page: A7

 
 
Museum guild schedules trip to historic San Francisco home

By Amy Maginnis-Honey | From Page: A8

 
3 die in I-680 crash; 2 from Vacaville

By Ian Thompson | From Page: A9, 10 Comments

 
Suisun City police log: Aug. 25, 2014

By Glen Faison | From Page: A12

Fairfield police log: Aug. 24, 2014

By Glen Faison | From Page: A12

 
Fairfield police log: Aug. 23, 2014

By Glen Faison | From Page: A12

Suisun City police log: Aug. 24, 2014

By Glen Faison | From Page: A12

 
Suisun City police log: Aug. 23, 2014

By Glen Faison | From Page: A12

Fairfield police log: Aug. 25, 2014

By Susan Hiland | From Page: A12

 
.

US / World

Obama defends handling of veterans affairs issues

By The Associated Press | From Page: B8, 10 Comments

 
American woman held hostage in Syria

By The Associated Press | From Page: B8

Arab strikes in Libya show impatience with US

By The Associated Press | From Page: B8, 1 Comment

 
AP sources: US surveillance planes fly over Syria

By The Associated Press | From Page: B8, 2 Comments

Napa quake stirs clamor for warning system

By The Associated Press | From Page: B8

 
Putin and Poroshenko meet for bilateral talks

By The Associated Press | From Page: B8, 1 Comment

Group files petition to idle coastal nuke plant

By The Associated Press | From Page: B8

 
Israel, Hamas agree to open-ended Gaza cease-fire

By The Associated Press | From Page: B8, 1 Comment

Los Angeles schools halt iPad deal amid criticism

By The Associated Press | From Page: B8

 
Report finds 1,400 children exploited in UK town

By The Associated Press | From Page: B8, 1 Comment

Police: Slain woman ID’d ex-deputy as her attacker

By The Associated Press | From Page: B8

 
Officials: Instructor accidentally killed by girl

By The Associated Press | From Page: B8, 11 Comments

Judges blast Indiana, Wisconsin gay marriage bans

By The Associated Press | From Page: B8

 
UN panel: Global warming human-caused, dangerous

By The Associated Press | From Page: B8, 1 Comment

.

Opinion

How to reduce taxes without busting the budget

By Ramesh Ponnuru | From Page: A11

 
Abandoned carts are everyone’s responsibility

By Letter to the Editor | From Page: A11, 14 Comments

Editorial cartoons for Aug. 27, 2014

By Daily Republic Syndicated Content | From Page: A11

 
Question of the week: Is US policy on hostages correct?

By Daily Republic | From Page: A11

Obama risks alienating Latinos from Dems

By Thomas Elias | From Page: A11, 1 Comment

 
.

Living

Today in History: Aug. 27, 2014

By The Associated Press | From Page: A2

 
Community Calendar: Aug. 27, 2014

By Susan Hiland | From Page: A2

We were good parents. Why won’t our adult children help us out?

By Kathy Mitchell and Marcy Sugar | From Page: B6

 
Horoscopes: Aug. 27, 2014

By Holiday Mathis | From Page: B6

Choosing chutney

By Mcclatchy-Tribune News Service | From Page: B7

 
Banishing the blues with healthy blueberry muffins

By Sara Moulton | From Page: B7

.

Entertainment

TVGrid

By Daily Republic Syndicated Content | From Page: A7

 
Women talk about sports on CBS Sports Network

By The Associated Press | From Page: A7

Miley Cyrus’ date wanted by Oregon police

By The Associated Press | From Page: A7

 
NBC’s Emmycast logs robust 15.6 million viewership

By The Associated Press | From Page: A7

.

Sports

 
Serena Williams beats American teen at US Open

By The Associated Press | From Page: B1

Carter’s HR in 8th leads Astros over A’s 4-2

By The Associated Press | From Page: B1 | Gallery

 
US teen Bellis, 15, stuns Cibulkova at US Open

By The Associated Press | From Page: B1

Raiders CB DJ Hayden to start season on PUP list

By The Associated Press | From Page: B1

 
49ers prepare for possible Aldon Smith suspension

By The Associated Press | From Page: B1

Bumgarner flirts with perfection, finishes with 1-hitter in Giants win

By The Associated Press | From Page: B2 | Gallery

 
No reason to feel sorry for Jim Furyk

By The Associated Press | From Page: B2

TMS 2015 schedule springs back to night race

By The Associated Press | From Page: B2

 
Love struck: Kevin Love pledges commitment to Cavs

By The Associated Press | From Page: B2

Sarkisian: USC looking into Shaw’s heroic story

By The Associated Press | From Page: B2

 
Davis, US men beat Slovenia in basketball exhibition

By The Associated Press | From Page: B2

Latest Astrodome proposal: massive indoor park

By The Associated Press | From Page: B2

 
.

Business

UN health agency urges crackdown on e-cigarettes

By The Associated Press | From Page: B8, 1 Comment

 
Survey: US consumer confidence near a 7-year high

By The Associated Press | From Page: B8, 1 Comment

Burger King buys, plans expansion of Tim Hortons

By The Associated Press | From Page: B8, 1 Comment

 
.

Obituaries

Florentino”Paul” Castaneda Bersola

By Susan Hiland | From Page: A4

 
Nadine L Wetherell

By Susan Hiland | From Page: A4

Lyle Cullum

By Nancy Green | From Page: A4, 1 Comment

 
.

Comics

Garfield

By Daily Republic Syndicated Content | From Page: B5

 
Dilbert

By Daily Republic Syndicated Content | From Page: B5

For Better or Worse

By Daily Republic Syndicated Content | From Page: B5

 
Pickles

By Daily Republic Syndicated Content | From Page: B5

Get Fuzzy

By Daily Republic Syndicated Content | From Page: B5

 
Baldo

By Daily Republic Syndicated Content | From Page: B5

Blondie

By Daily Republic Syndicated Content | From Page: B5

 
Beetle Bailey

By Daily Republic Syndicated Content | From Page: B5

Peanuts

By Daily Republic Syndicated Content | From Page: B5

 
Baby Blues

By Daily Republic Syndicated Content | From Page: B5

Frank and Ernest

By Daily Republic Syndicated Content | From Page: B5

 
Zits

By Daily Republic Syndicated Content | From Page: B5

Rose is Rose

By Daily Republic Syndicated Content | From Page: B5

 
B.C.

By Daily Republic Syndicated Content | From Page: B5

Wizard of Id

By Daily Republic Syndicated Content | From Page: B5

 
Sally Forth

By Daily Republic Syndicated Content | From Page: B5

Sudoku

By Daily Republic Syndicated Content | From Page: B6

 
Crossword

By Daily Republic Syndicated Content | From Page: B6

Word Sleuth

By Daily Republic Syndicated Content | From Page: B6

 
Cryptoquote

By Daily Republic Syndicated Content | From Page: B6

Bridge

By Daily Republic Syndicated Content | From Page: B6