3 compounding pharmacies sue Express Scripts over blocked coverage
- Express Scripts, the largest pharmacy benefits manager in the U.S., has been refusing to cover approximately 1,000 active ingredients used by compounding pharmacies to make certain ointments, creams, and powders found in topical treatments.
- According to Express Scripts, the ingredients in question are too expensive, with a current average cost of $1,100 (up from $90).
- Three compounders have filed a lawsuit accusing Express Scripts of violating federal law by not following the terms of the affected health plans.
The stand-off between Express Scripts and compounding pharmacies is based on a number of disagreements. Express Scripts feels that the prices of the ingredients in question are untethered from reality. On the other side, the compounders assert that Express Scripts must abide by the terms of the health plans that fall under benefit manager's umbrella. For example, if there is no clause that excludes certain medicines and ingredients—and the health plan is designed to cover prescription drugs—the compounders argue that the product must be covered.
Apparently, some patients have been receiving letters from Express Scripts informing them about an unspecified charge in their compound medications benefits and citing lack of FDA approval for such medications. The compounders are fighting back aggressively, despite some of the concerns about the need for additional regulatory oversight over these medication providers.