Harvard Pilgrim sued for not covering compounded drugs

Massachusetts's second-largest insurer Harvard Pilgrim is facing a lawsuit from three pharmacies over its decision to stop covering compounded drugs that allegedly violates state law and contractual obligations.

Harvard Pilgrim announced it would drop coverage of compounded drugs, which are specially mixed for patients who need formulations or doses not widely available, effective Aug. 7 because of cost and safety concerns.

The three compounding pharmacies--Bird's Hill Pharmacy in Needham, Hopkinton Drug and Johnson Compounding and Wellness Center in Waltham--claim  Harvard Pilgrim's new policy will harm patients who can't take similar medications in place of compounded drugs, reported the Boston Herald.

"Harvard Pilgrim's callous decision to cut off coverage is a major blow to the many patients across Massachusetts who depend on compounded medications, either because there is no commercially manufactured drug available or because they need a customized version," Henry Abbott, owner of Bird's Hill Pharmacy, said in a statement. "Many of our patients will no longer be able to afford these medications without insurance coverage, and we are worried about what this decision will mean for their health."

The compounding pharmacies said some medical conditions don't have corresponding standard drugs, and allergies or other conditions often prevent patients from taking standard medications, thereby making compounded drugs medically necessary. Therefore, Harvard Pilgrim should still cover these medications, the Boston Business Journal reported.

They added that Harvard Pilgrim is statutorily mandated to cover compounded drugs that are medically necessary.

What's more, the pharmacies questioned Harvard Pilgrim's continued coverage of compounded drugs for children but not adults since the new policy only affects adults, according to the Waltham News Tribune.

To learn more:
- read the Boston Herald article
- see the Boston Business Journal article
- check out the Waltham News Tribune article

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