Insurers and pharmacy benefit managers hijacking doctor-patient relationship
FAIRHOPE, Ala., July 14, 2014 /PRNewswire/ -- Patients and patient advocates are rallying on behalf of millions of patients as Express Scripts and other major pharmacy benefit managers (PBMs) begin unprecedented cuts in prescription medication coverage. The cuts will directly impact millions of patients who rely on compounded medicines to relieve an array of medical conditions, including persistent pain from cancer, diabetes and other illnesses. Express Scripts has announced that they will begin notifying some patients on July 15.
In a matter of days more than 100 physicians, pharmacists, patients and patient advocate organizations have come together as Patients and Physicians for Rx Access, a new coalition that is working to stop or reverse the loss of benefits for compounded medications. Patients who lose coverage may be forced to pay the full cost of their custom-formulated medications, or their physicians may be compelled to prescribe other medications that are less effective for that patient.
"Express Scripts and other pharmacy benefit managers are hijacking the sacred relationship between physicians and patients in order to increase their company's profits, without any prior notice to those who are most affected," said Jay McEniry, executive director of Patients and Physicians for Rx Access. "Furthermore, the insurers are creating a smokescreen of misinformation to cover themselves as they shift costs to patients. It's unfair, unnecessary and a disservice to millions of patients and their physicians."
Companies that have announced plans to eliminate or severely limit coverage include Express Scripts, United Healthcare/Optum Rx, CVS/Caremark, Catamaran, Harvard Pilgrim and some Blue Cross Blue Shield organizations. Express Scripts, the country's largest pharmacy benefit manager, began quietly disclosing the cutbacks in mid-to-late June, with substantial cuts taking effect this month. The cutbacks will end prescription coverage for 750,000 to 1 million patients through Express Scripts alone.
Compounded medicines allow physicians to tailor treatment to the unique needs of individual patients. Compounds are used to avoid allergic reactions to gluten and dyes found in some mass-produced medications, for hormone replacement therapies, and for other patients with specific needs. Importantly, physicians are increasingly prescribing compounded medications for pain management, in part as a response to the Food and Drug Administration's 2012 mandate to seek alternatives to addictive opioid narcotics.
"Compounded medications are a critical tool for physicians. We prescribe compounded medications because we see these medications work for our patients; in many cases, we turn to compounded medications after trying many options," said Dr. Todd B. Edmiston of Fairhope, Alabama. "As an orthopedic surgeon, I see many of my patients struggle with pain management. Multiple studies show compounded medicines can be highly effective for many patients, particularly those with localized and persistent pain. Compounded medications may work when prescription narcotics are not effective or not recommended. Compounds also allow patients to reduce or avoid use of oral narcotics that affect the patient's entire system and contribute to the epidemic of opioid abuse in this country."
The coalition disputes claims by Express Scripts and others that the cost and effectiveness of compounded medicines justify the cutbacks, even as physicians are increasing the use of the medications.
"The insurers' arguments are disingenuous and misleading," McEniry said. "Doctors are prescribing more compounded medications because they work and address the unique needs of individual patients. As for cost, companies like Express Scripts have mechanisms to control costs without disallowing medications and blaming their costs on pharmacists."
Coalition leaders want insurers and pharmacy benefit managers to manage costs responsibly and maintain patient access, rather than slamming the door on millions of people and an entire category of medicines.
Coalition member Tom Christie of Anoka, Minnesota, is the co-founder of a nonprofit organization for people with relapsing polychondritis, a painful and potentially fatal condition. Christie said, "Many of us with this incurable condition have tried heavy doses of narcotic pain killers that can have serious side effects and may give mixed results. Over-the-counter medications are mostly good for muscle aches, but did little to address my inflammation and pain. My doctor recently prescribed a new compounded ointment that stops the pain in minutes. It's simply wrong for insurers to take away coverage for such essential medications."
Organizations represented in the quickly growing coalition include the Veterans Advocacy Group of America, Kidney Cancer Association, Relapsing Polychondritis Awareness and Support Foundation, Arthritis Foundation, dozens of independent community pharmacists and pharmacies and others, including patients, physicians and students.
The coalition website, www.saverxaccess.org, helps patients better understand and navigate these issues. On the website, patients, physicians, pharmacists, patient advocates and others can find useful information to help them fight back and protect their access to the medicines their doctors have prescribed.
"The coalition's rapid and continuing growth is an indication of the public outrage that will come as millions of patients and their families are caught by the unprecedented and largely unpublicized denial of coverage," McEniry said. "We simply can't sit back and allow insurance companies to dictate physician decisions regarding the best course of treatment for their patients. We must act now."
About Patients and Physicians for Rx Access
Patients and Physicians for Rx Access is a coalition consisting of individual patients, patient advocacy groups, pharmacists, physicians, pharmacies and healthcare organizations focused on raising awareness about compounded prescription access. The coalition formed to protect patients from the immediate threat from a growing number of pharmacy benefit management firms and insurers who are working quietly to deny coverage for the vast majority of compounded medicines.
SOURCE Patients and Physicians for Rx Access