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Battle between insurance and compounded drugs could harm patients

On Behalf of | May 4, 2015 | Injuries |

Insurance companies are increasingly denying coverage of compounded drugs, or mixtures tailor made for patients.

The use of compounded drugs is not a novel concept. Pharmacists and physicians alike have been putting together medications for patients since the practice of medicine began. Presently, this often involves mixing liquid medications for those who cannot take a pill form or removing an ingredient that may lead to an allergic reaction. Essentially, compounding occurs any time two or more drugs are mixed together, altered or combined to create a tailored medication for an individual patient. Current practices generally require a licensed pharmacist or physician to either complete or supervise the process. Although in practice for years, compounded drugs are gaining attention in the media since insurance companies are beginning to deny coverage.

Some of these medications can be costly. A recent article by The New York Times addresses the issue, noting some compounded pain creams can cost thousands of dollars. Insurance companies are fighting back, refusing to offer coverage for some ingredients used in these medications. Although the denial of claims to patients requesting their insurance provider cover the cost of certain compounded medications leads to a significant cost savings for the insurance companies, the practice could ultimately hurt the patient.

Regulations Contribute to Inhibited Access to Medication

In addition to insurance companies, various regulations also make access to these medications increasingly difficult. Part of the issue stems back to standards in billing practices set by the National Council on Prescription Drug Programs in 2012. The Wall Street Journal recently reported that changed billing practices led to increased prices, since the medications were charged based on all ingredients instead of the original practice which based the price on just the most expensive ingredient.

These regulations make it difficult for medical providers to properly care for patients, effectively removing the option of prescribing some medications. Additional regulations were enacted in November of 2013 by President Obama. The Drug Quality and Security act is designed to provide additional oversight to the process used to compound medications but also leads to further delay and difficulty.

Legal Counsel Can Help

Medical providers, including physicians and pharmacists, attempting to ensure coverage for patients can benefit from the counsel of an attorney. Insurance companies must meet their obligations, and those who are not fulfilling their end of a contractual agreement to cover certain medications can be held accountable.

As a result, those who are fighting with insurance companies to cover medications are wise to seek the counsel of an experienced health care law attorney. This legal professional can review your case and work to better ensure your legal rights are protected.