Thursday, October 28, 2010
Taking a medication by mouth is not the only way to deliver chemicals into the body. The skin is capable of absorbing chemicals both toxic, in the case of hazardous material, and therapeutic, in the case of medications. The effectiveness of transdermal absorption depends on the area of applic...
In response to “However, the cost of custom compounded medications is prohibitive for most people.”
Please don't rule out custom compounded medications because of cost. Although I haven't used anti-inflammatory medications, I've used other ones and my insurance has always covered. Research first, you may be surprised by both your cost and the effectiveness of the medication. See the Questions and Answers below:
Q: Will my insurance cover compounded medications?
Because compounded medications are exempt by law from having the National Drug Code ID numbers that manufactured products carry, some insurance companies will not directly reimburse the compounding pharmacy. However, almost every insurance plan allows for the patient to be reimbursed by sending in claims forms. While you may be paying a pharmacy directly for a compounded prescription, most insurance plans should cover the final cost.
Q: Is compounding expensive?
Compounding may or may not cost more than conventional medication. Its cost depends on the type of dosage form and equipment required, plus the time spent researching and preparing the medication. Fortunately, compounding pharmacists have access to pure-grade quality chemicals which dramatically lower overall costs and allow them to be very competitive with commercially manufactured products.
Sources:
PCCA (Professional Compounding Centers of America)
Boulevard Pharmaceutical Compounding Center
Daniel's Drug Compounding and Wellness Pharmacy
Cox Pharmacy
Does compounded medication cost more than other medication?
Not necessarily so. Compounded medication can cost less than conventional mass marketed medication in instances where small doses are compounded or ingredient costs are low. Compounded medication can cost more when formulations are lengthy or ingredient costs are high.
Source: Customized Health Solutions
Although the compounding pharmacy industry paints a rosey picture, the reality of insurance coverage for prescription medications has been a little disappointing. Generally, the cost of compounded medications has been prohibitive in my experience. Maybe things are different here in California, but in the past 10 years that I have been prescribing compounded medications, I have gotten many rejection letters from the insurance companies that read as follows:
From Blue Shield of California reguarding compounded Ketoprofen (a topical compounded anti-inflammatory):
"The medication requested is compounded by a pharmacy and is not available from a manufacture. Unfortunately, there are no published guidelines that ensure consistency in the potency of this compounded prescription. Furthermore, we are unaware of any peer-reviewed published articles supporting the efficacy of this compound. Please talk to your physician regarding a manufactured drug that may work for you."
I am always disappointed when I get such a letter, but it never keeps me from trying because different insurance plans have different guidelines. For example, Blue Cross authorized a particular compound for an individual. But when the same individual changed insurance companies to Blue Shield, that person was unable to get the same compound drug covered. It is a very frustrating system for me and the person needing customized medications.
Thankfully, these new manufactured topical NSAID's are now available and provide good option for treating pain.
Dr. Chrisitina Lasich, MD
I am very happy to see that you have written
"Generally, the cost of compounded medications has been prohibitive in my experience." in response to Pam's comment. I appreciate that you are speaking from your experience, and not applying it to all compounded medications.
Mine DOES pay for some compounded medications if there is a good reason that the agent has to be used in that form, and there is no other way of supplying that medicine.
Perhaps not always on the first go-around, but that's what the appeals process is there for, and while frustrating, is there to be utilized.
I've had quite a few things compounded, at different pharmacies in different states. With some of the medicines, the total fee was just the pharmacy cost + a copay. Not prohibitive at all. Of course, everyone's experiences may vary!
It looks like BC & BS does have a problem with compound medications but I don't think most other insurance companies deny them outright like this. Like I said, it's always best to research first. That may mean the patient checks their insurance coverage first OR the doctor can ask for pre-certification.
There are ways to get around insurance coverage problems like this. For example, a letter of medical necessity stating why a patient must use compound drugs may be helpful. Sometimes something like an allergy to dye in the standard medication or gastric stasis may prevent someone from taking a pill and may be the deciding factor for insurance coverage.
BUT your article isn't about insurance coverage. You stated that the cost is prohibitive to MOST people. It's not. Maybe SOME but not MOST. Just because something isn't covered by insurance doesn't mean that it's not affordable.
Interesting, Pam. I have a BCBS plan. I guess I'm lucky :-)
I also check insurance coverage- know about precertifications that I'd need, call the pharmacy, get all my eggs in a basket when I'm doing things "outside the box" medicinally. It's saved me a lot of money, time, and frustration.
My doctors have thanked me for knowing what I'm going to need from them if they prescribe things (compounded meds, DME equiptment, ect...) They appreciate that I know what my plan covers.
Knowledge is power!
I have Untied Healthcare, and I live in Missouri. My UHC plan will not pay for topical medications. Cost Of Pennsaid: 159.88. I have to take a lot of medication for Inflammatory Arthritis, Fibromyalgia, Osteoarthritis, High BP and Asthma. My co-pays for most: 35.00 a month for each prescription. I have the best plan they offer where I work and I pay the highest premiums for that plan. Paying for my meds is a struggle, but I did get the Pennsaid and I paid for it directly It seems to be helping. My rheumatologist knew my insurance wouldn't pay for the Pennsaid and told me it would be 159.00. I appreciated the heads up. That way I wasn't in sticker shock when I went to the pharmacy.
I wonder if your insurance would pay for the Pennsaid if they thought it was for acute pain as opposed to the chronic conditions of RA and FM??? Might be worth a second look and go around with United Healthcare.
Dr. Christina Lasich, MD
That is a thought. I can't take NSAIDs orally for two reasons. The first rheumy I saw ten yrs ago told me to take 1200 mg of Ibuprofen a day for a year. Yikes! I didn't realize what it could/would do to my stomach. Secondly, I take Lisinopril as one of my bp meds and NSAIDs interfere w/Lisinopril, my doctor says. They sort of work against each other, I guess. They do not want to change my bp meds...I've already been down that road. So, I think the Pennsaid is a good option for me. I am going to call UHC next week and talk to them. Do you think this would be a good reason to them approve this med for me...the stomach issues and bp issues? I am calling my rheumy next week, too. My right wrist is getting more bothersome. I was just trying to peel some potatoes and it was painful. I am going to ask him if I can use the Pennsaid on both wrists at the same time. Thanks, Dr L. V
According to Fingertip Formuary, United Health Care does not cover Pennsaid in Missouri. PERIOD. If something is not covered by an insurance company, I don't think they will reconsider it for any reason, including a different diagnosis. V, you may want to ask your doctor to visit the Pennsaid site. There's an option for physicians to request samples for you. Dr. L. can request samples for her patient's too.V, Partnership for Prescription Assistance (PPARX) may be able to help. Pennsaid is not on their list but they may be able to direct you to a resource that can help.
Dr. L., Ketoprofen tablets, however, are on PPARX's list, Through the PPARX website I was able to find out Xubex Pharmaceuticals provides NO COST and LOW COST help through their patient assistance program for the tablets. You may want to contact them to see if they can direct you to a source that can help with the cost of the topical Ketoprofen. It looks like Xubex has a good Patient Assistance Program. If you have any patients, using the tablets, who need financial assistance, you may want to refer them to this site.
So, back to my original point about the cost of custom compounded medication being prohibitive for most people. The cost of any medication may not be out of reach even for those who have no insurance and little or no income. If you doctor prescribes a medication that you don't have insurance coverage for or you cannot afford, don't rule it out because the cost may be prohibitive. Do your homework. Ask for samples. And check to see if you eligible for any programs that PPARX offers. Finally, check with your pharmacy. Many people don't realize their pharmacy may provide you with a discount for medications not covered by insurance. (I'm currently using a medication that is not covered by insurance. It's about $130 a month. My pharmacy is associated with a discount service and I only pay $8.90 a month for it.)
As braindrane said, "Knowledge is power!" Educate yourself. If you don't check out your options you may miss out on a medication that could really make a difference.
OH NO! My post got reformatted and the line space between paragraphs disappeared. I'm really sorry if this is hard to read!
Thank you for the information. I should not have said that paying for my meds is a "struggle". It is getting to take more and more of my income, but I am thankful that I can pay for my meds at this time. I am a little worried when I contemplate the future. I hope I am able to continue working, for many reasons. I have worked all my life, and I don't want to stop now. I feel fortunate to have a good job, especially considering the economic environment we all find ourselves dealing with today. I am in the financial services field, and that is a bit dicey at the moment. We finance office equipment, furniture, phone systems, etc. I am old enough that it would be difficult for me to find another position quickly, especially in the rural area where we live. My elderly parents live with my husband and I, and I do struggle keeping up w/work, running errands for them, etc. But I am so thankful for what I am able to do. And I am thankful for doctors who care enough and have the knowledge to help me live a fuller life with the aid of medication. I know doctors are just as frustrated with the insurance companies as many of their patients. We have to pay high premiums and medication costs. Doctors have to pay outrageous malpractice insurance premiums and see way too many patients. Our system needs some tweaking, but all in all, I'm happy I live in the US and I'm grateful there are still doctors who are genuinely dedicated to easing the pain of their patients. Thanks again, V
That's a good idea If it IS for acute pain. If it's really for chronic pain, and the doctor just says it's for acute pain, that's insurance fraud. If the insurance company ever found out, both the doctor and the patient could be in deep trouble.
Viv
My wrist has been swollen for three months, and the swelling is getting worse. Now my right wrist is swelling. They were not swollen when I first saw the rheumatologist earlier this year. So...not sure if they would be classified accute or chronic. If it doesn't go away, I suppose it will be classified as chronic, but at the moment, I would say it is still considered accute. Since I am not a doctor, I really don't know. Just makes sense to me, as it was not nearly as evident a month ago, and the doctor wasn't concerned about it a month ago. Regardless, UHC doesn't pay for topical medicine in Missouri according to the previous post by one of the members on this site. Just one of those things. If the medicine helps, I will continue to buy it. If not, I will save my money.