I've been on the road visiting with customers and I'm hearing a lot about compounds. Most of us are aware that compound medications are intended to provide certain medications in forms or dosages not commercially available, therefore necessitating a pharmacist create or mix a compound medication. More of us are becoming aware that compounding represents a significant and growing clinical and financial risk in workers' compensation. Only a few of us have clear and well documented processes and procedures for dealing with these prescriptions.
While compounding isn't new, the attention being paid to it is, in fact, overdue. Recently, Express Scripts was sued by several compounding pharmacies for allegedly issuing blanket denials for over 1,000 different active ingredients in compound medications (this policy was in the group health space, not work comp). While we know such blanket denials aren't feasible in work comp, the tug of war between the compounding pharmacies and the payer community is playing out in our space all the same.
Compounds can be medically necessary and effective, but use should be limited to situations where the oral medication has proven ineffective and/or has produced serious side effects. Clearly, we're seeing a frequency of compound prescriptions in work comp that far exceeds what is likely medically reasonable and necessary.
So what's your strategy? What are you doing? Many compound pharmacies are making obscene amounts of money exploiting gaps in the claims management processes of work comp payers. How do you plan to close those gaps?
Two post scripts:
There are a precious few compounding pharmacies trying to do this right. You should be looking for them and putting them into your networks.
And for a more comprehensive view on compounds in work comp, I'd direct you to the excellent CompPharma white paper from earlier this year.
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