an article from yesterday
U.S. prescription spending increase in 2014 highest in over a decade
http://www.businessinsurance.com/article/2015.../150319977
Prescription drug spending increased 13.1% in the United States last year, attributed partly to an increase in spending for specialty drugs, according to Express Scripts Inc.
The overall increase in national drug spending last year was the highest rate in more than a decade, according to the Express Scripts 2014 Drug Trend Report released Tuesday. The study included group health claims and Medicare and Medicaid prescriptions.
For specialty medications, such as hepatitis C therapies and compounded drugs, utilization increased 5.8% and cost increased 25.2% from 2013 to 2014, the report states.
Specialty medications accounted for 31.8% of overall drug spending in 2014, up from 27.7% the year prior, according to the report.
“Hepatitis C and compounded medications are responsible for more than half of the increase in overall spending,” Express Scripts said in a statement. The St. Louis-based pharmacy benefit manager noted that the United States spent about 743% more on hepatitis C drugs in 2014 than it did in 2013.
In 2014, for the first time, compounded drugs ranked among the top 10 therapy classes, according to Express Scripts. Drugs for diabetes and high blood cholesterol were the first and second largest therapy classes used last year, the report said.
“Since the implementation of new regulations in 2012 requiring that all components of compounded drugs be specified and billed at the ingredient level rather than being rolled up under the highest priced ingredient, bulk manufacturers and compounding pharmacies have raised prices substantially for the components of many compounded drugs,” the report states. “The result has been unsustainable cost increases.”
If compounded drugs were excluded, total overall drug spend would have increased 10.4% rather than 13.1%, according to the report.
Other costly specialty treatments for conditions like multiple sclerosis and cancer accounted for more than 31% of total drug spending in 2014, according to the statement.
For non-specialty prescription medications, utilization decreased 0.1% and cost increased 6.5%, leading to a 6.4% increase in spending from 2013 to 2014, the report states.
“For the past several years, annual drug spending increases have been below the annual rate of overall health care inflation in the (United States), but that paradigm is shifting dramatically as prices for medications increase at an unprecedented and unsustainable rate,” Dr. Glen Stettin, senior vice president of clinical, research and new solutions at Express Scripts, said in the statement. “Now, more than ever, plans need to tightly manage the pharmacy benefit, implement smarter formularies, control compounded medication use and offer the right clinical support to ensure all patients are able to achieve the best possible health outcomes at a price our country can afford.”
Here's another snippet I found on caremark's intention from last year to limit compound meds.
CVS/Caremark
On May 30, CVS/Caremark announced plans to their provider manual related to copayment collection and claims for compounds. Click here to see the copy of this announcement obtained by IACP.
As with many other PBMs and insurance plans, participating pharmacy providers are expected to collect the full amount of the copayment from the beneficiary – no discounts, no waivers, not “copay coupons” – unless otherwise permitted by either Caremark or state law. PBMs are auditing copayment collection documentation and it looks like Caremark may be considering the same. Failure to collect the full copayment could lead to termination of a pharmacy’s network contract.
While documentation of copayment collection is an important “must do” in your pharmacy, Caremark is now requiring a completely different and onerous type of documentation for any and all compounded preparations submitted for reimbursement.
Effective immediately, compounders not only have to include the NDC number of each ingredient use in the compound they must also have “at least two (2) scientifically valid studies in peer-reviewed journals supporting the clinical efficacy of the additional ingredients” for each of those ingredients and have those studies available if Caremark requests them.
“This is nothing more than an administrative hurdle designed to deny coverage for legitimate prescriptions and keep beneficiaries from obtaining the medications they need,” says IACP Executive Vice President/CEO David G. Miller, RPh. “It’s discrimination… pure and simple.” With an estimated fifty percent of all prescription drugs used for extra-label purposes, Caremark has an established track record of reimbursing for medications for which no clinical studies exist. Yet, the PBM has not nothing to address extra-label dispensing or reimbursement. Only compounds are singled out.
Of particular concern to IACP is that the peer reviewed medical literature on compounded preparations and their individual ingredients is scant. While the IACP Foundation has supported research into some ingredients and preparations – most notably BHRT – there are literally thousands of APIs, inactive ingredients, bases, flavorings, dyes, etc. for which studies have never been completed. Even the profession’s most referenced peer-reviewed journal, the International Journal of Pharmaceutical Compounding, doesn’t have the extent of information as Caremark is requesting.
U.S. prescription spending increase in 2014 highest in over a decade
http://www.businessinsurance.com/article/2015.../150319977
Prescription drug spending increased 13.1% in the United States last year, attributed partly to an increase in spending for specialty drugs, according to Express Scripts Inc.
The overall increase in national drug spending last year was the highest rate in more than a decade, according to the Express Scripts 2014 Drug Trend Report released Tuesday. The study included group health claims and Medicare and Medicaid prescriptions.
For specialty medications, such as hepatitis C therapies and compounded drugs, utilization increased 5.8% and cost increased 25.2% from 2013 to 2014, the report states.
Specialty medications accounted for 31.8% of overall drug spending in 2014, up from 27.7% the year prior, according to the report.
“Hepatitis C and compounded medications are responsible for more than half of the increase in overall spending,” Express Scripts said in a statement. The St. Louis-based pharmacy benefit manager noted that the United States spent about 743% more on hepatitis C drugs in 2014 than it did in 2013.
In 2014, for the first time, compounded drugs ranked among the top 10 therapy classes, according to Express Scripts. Drugs for diabetes and high blood cholesterol were the first and second largest therapy classes used last year, the report said.
“Since the implementation of new regulations in 2012 requiring that all components of compounded drugs be specified and billed at the ingredient level rather than being rolled up under the highest priced ingredient, bulk manufacturers and compounding pharmacies have raised prices substantially for the components of many compounded drugs,” the report states. “The result has been unsustainable cost increases.”
If compounded drugs were excluded, total overall drug spend would have increased 10.4% rather than 13.1%, according to the report.
Other costly specialty treatments for conditions like multiple sclerosis and cancer accounted for more than 31% of total drug spending in 2014, according to the statement.
For non-specialty prescription medications, utilization decreased 0.1% and cost increased 6.5%, leading to a 6.4% increase in spending from 2013 to 2014, the report states.
“For the past several years, annual drug spending increases have been below the annual rate of overall health care inflation in the (United States), but that paradigm is shifting dramatically as prices for medications increase at an unprecedented and unsustainable rate,” Dr. Glen Stettin, senior vice president of clinical, research and new solutions at Express Scripts, said in the statement. “Now, more than ever, plans need to tightly manage the pharmacy benefit, implement smarter formularies, control compounded medication use and offer the right clinical support to ensure all patients are able to achieve the best possible health outcomes at a price our country can afford.”
Here's another snippet I found on caremark's intention from last year to limit compound meds.
CVS/Caremark
On May 30, CVS/Caremark announced plans to their provider manual related to copayment collection and claims for compounds. Click here to see the copy of this announcement obtained by IACP.
As with many other PBMs and insurance plans, participating pharmacy providers are expected to collect the full amount of the copayment from the beneficiary – no discounts, no waivers, not “copay coupons” – unless otherwise permitted by either Caremark or state law. PBMs are auditing copayment collection documentation and it looks like Caremark may be considering the same. Failure to collect the full copayment could lead to termination of a pharmacy’s network contract.
While documentation of copayment collection is an important “must do” in your pharmacy, Caremark is now requiring a completely different and onerous type of documentation for any and all compounded preparations submitted for reimbursement.
Effective immediately, compounders not only have to include the NDC number of each ingredient use in the compound they must also have “at least two (2) scientifically valid studies in peer-reviewed journals supporting the clinical efficacy of the additional ingredients” for each of those ingredients and have those studies available if Caremark requests them.
“This is nothing more than an administrative hurdle designed to deny coverage for legitimate prescriptions and keep beneficiaries from obtaining the medications they need,” says IACP Executive Vice President/CEO David G. Miller, RPh. “It’s discrimination… pure and simple.” With an estimated fifty percent of all prescription drugs used for extra-label purposes, Caremark has an established track record of reimbursing for medications for which no clinical studies exist. Yet, the PBM has not nothing to address extra-label dispensing or reimbursement. Only compounds are singled out.
Of particular concern to IACP is that the peer reviewed medical literature on compounded preparations and their individual ingredients is scant. While the IACP Foundation has supported research into some ingredients and preparations – most notably BHRT – there are literally thousands of APIs, inactive ingredients, bases, flavorings, dyes, etc. for which studies have never been completed. Even the profession’s most referenced peer-reviewed journal, the International Journal of Pharmaceutical Compounding, doesn’t have the extent of information as Caremark is requesting.
