Access to Compounded Medication Coverage for 140,000 TRICARE Military Heroes and Families Clears Major Hurdle
Beneficiary Advisory Panel Decision Sets Stage for Continued Coverage; Final Decision Rests with TRICARE Management Activity Director
FAIRHOPE, Ala., Jan. 20, 2015 /PRNewswire/ -- Two non-profit advocacy organizations, Patients and Physicians for Rx Access and International Academy for Compounding Pharmacists (IACP), urge the Defense Health Agency to cover compounded medications without restriction under TRICARE following a split decision by two internal committees. The Defense Health Agency administers the TRICARE Health Plan, which provides worldwide medical, dental and pharmacy benefits to more than 9.5 million uniformed service members, retirees and their families. According to the Department of Defense, 140,000 TRICARE beneficiaries filled 360,000 prescriptions for compounded medications between June 2013 and May 2014.
In late 2014, the Department of Defense Pharmacy and Therapeutics (P&T) Committee recommended significant restrictions on ingredients commonly used in compounded formulations and a strict manual prior authorization process for prescribers and patients. In a win for patients and patient advocates, TRICARE's Beneficiary Advisory Panel (BAP) rejected the P&T Committee's unnecessarily restrictive and burdensome recommendations. Now faced with divergent committee recommendations, the final determination on the fate of compounded medication coverage for military heroes and families rests in the hands of the Director, TRICARE Management Activity.
"We understand the Defense Health Agency's need to balance budget realities with patient access to care," said Jay McEniry, executive director of Patients and Physicians for Rx Access. "In the span of a year, 140,000 military heroes and families filled 360,000 prescriptions for compounded medications. This includes children and veterans whose healthcare needs cannot be met by manufactured medicines. Clearly there is a need, and as a coalition we are committed to helping the Defense Health Agency find a way to manage costs without sacrificing care."
David Miller, RPh, executive vice president of IACP, shares a similar view. "IACP believes that all patients, regardless of their insurance plan, should have access to compounded medications whenever their physician determines that a compound is the best treatment for them," said Miller. "We strongly encourage the passing of laws and regulations that result in complete, consistent compounded prescription drug coverage across all government-funded programs, including TRICARE. We join Patients and Physicians for Rx Access in offering to work with the Defense Health Agency so that this important benefit remains available to uniformed service members and their families."
Patients and Physicians for Rx Access and IACP recommend that the Defense Health Agency collaborate with industry stakeholders to determine means to provide cost-effective access to compounded medications without unnecessary formulary restrictions or cumbersome prior authorization requirements for prescribers and patients. Patients who suffer from chronic pain, diabetes and other conditions that limit the patient's ability to tolerate manufactured medications, depend on compounded medications. Often times, compounded medications are the only treatment option for these patients.
James McGee, a TRICARE beneficiary from Crestview, Florida, uses a compounded topical cream. "I suffer from constant pain in my neck and lower back," said McGee. "There are times that I have to take pain pills for the constant pain. I prefer not to take pills because of the side effects. This cream gives me some relief, enough so that I only turn to pain pills when I really have to."
About Patients and Physicians for Rx Access
Patients and Physicians for Rx Access is a coalition consisting of individual patients, patient advocacy groups, pharmacists, physicians, pharmacies and healthcare organizations working to save patient access to compounded medications. The coalition formed to protect patients from the immediate threat from a growing number of pharmacy benefit managers and insurance companies who are working quietly to deny coverage for these essential medications. For more information visit www.saverxaccess.org.
About the International Academy of Compounding Pharmacists
The International Academy of Compounding Pharmacists (IACP) is an association representing nearly 4,000 pharmacists, technicians, students and members of the compounding community who focus upon the specialty practice of pharmacy compounding. Compounding pharmacists work directly with prescribers including physicians, nurse practitioners and veterinarians to create customized medication solutions for patients and animals whose healthcare needs cannot be met by manufactured medications.
SOURCE Patients and Physicians for Rx Access
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