A properly designed compounding benefit can help control costs and quality

A properly designed compounding benefit that works with industry providers is more effective at controlling costs and quality than a negative approach that can limit patient care and potentially increase costs, according to Rich Moon, PharmD, Pharmacy Innovations, Jamestown, New York.

In a presentation delivered at the Academy of Managed Care Pharmacy (AMCP) meeting entitled Pharmacy Compounding and the Impact on Managed Care Pharmacy, Moon stressed that managed pharmacy care is responsible for understanding, managing and defining the need for compounding, as well establishing and monitoring regulations and managing cost.

The session provided a review of regulatory activity and managed care initiatives regarding compounded prescriptions, with particular focus on pain and scar creams.

Michael J. Tocco, RPh, president, Integrated Pharmacy Solutions, Inc., Melrose, Massachusetts, opened the session, briefly describing recent events that have led to tighter regulations of compounded prescriptions, including 65 deaths in 2012 because of unsafe compounding practices.

Saying that there is no question that much of compounding in the United States is needed, he stressed that most compounding companies cannot pass 795 regulations (i.e., regulations that provide guidance on preparation of nonsterile compounded formulations) and that as many as 50% of states are not compliant with 797 regulations (i.e., regulations that provide requirements for preparation of sterile drugs). The result, he said, is the creation of unsafe environments.

Cost is also a problem, he said, highlighting that the cost of compounded prescriptions has increased by as much as 100% to 200% because of inflated average wholesale prices, which, he said, was an unintended consequence of the National Council for Prescription Drug Programs (NCPDP) billing standard for compounds.

He urged pharmacists not to take the safety and cost issues of compounding lightly. “Even though compounding is a small financial part of the pharmacy benefit, we have a large safety and cost issue that needs corrected,” he said.

The benefit of better managing these issues instead of eliminating compounding from pharmacies was emphasized by Moon, who described the benefits of compounded prescriptions for pain creams and scar gels. These benefits include the reduced likelihood of addiction to and abuse of oral medications when using compounded pain creams for conditions such as shingles, phantom limb pain and diabetic nephropathy, as well as the ease of application and the ability to combine multiple ingredients and antibiotics directly to an affected area when using compounded wound and scar gels.

“A solidly designed benefit that manages compounding instead of eliminating it or allowing it to go unchecked allows the provision of needed services at a budget able level,” he said.

Ways to help better manage the benefits of compounding is to reign in nefarious operators of higher cost, overutilization, and questionable formula. He also emphasized the need to do outcomes studies within a network, and to examine the market as a whole.