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PSSNY Compounding Academy - Patient
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Compounding Academy - Patients

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Patient Awareness
Express Scripts


Patient Awareness

To effectively raise awareness each patient should do ALL of the following:

  • Send a letter to your Insurance Plan
  • Send a letter to your Employer
  • Send a letter to your State Legislatures
  • Contact the NYS Department of Health
  • Send a letter to your local news and media outlets

 


 BCBS of Western New York

  • What This Means to You:

    Blue Cross Blue Shield of Western New York sent out a letter stating that effective June 15th, all compounded medications will require pre-authorization.  Blue Cross Blue Shield states that compounded medications are not subject to a rigorous drug review process to ensure safe and effective use.  The letter also directs the patient to discuss with their doctor the possibility of using an alternate, commercially available medication.

    The majority of ingredients in compounded medications are purchased through FDA approved wholesalers, who are regularly inspected to ensure quality.  These ingredients must pass rigorous testing to show they comply with all United States Pharmacopeia standards.  All state and federal regulations allow pharmacies to use these bulk ingredients to make the highest quality product.

    We are asking you, the patient, to keep in mind that a significant number of people have unique health needs that off-the-shelf, one-size-fits-all prescription medication cannot meet.  These include the elderly, children, and those whom manufactured drug products are not available in the appropriate strength, dosage form, or composition.  For them and for you, customized medications are the only way to better health and those valuable preparations are available only by compounding.

    Blue Cross Blue Shield is attempting to deprive you of a medication that your doctor, after careful examination, has determined to be the most effective and appropriate therapy for you.  Requiring pre-authorizations will delay your treatment or perhaps result in a denial by the plan forcing you to pay out-of-pocket for your prescription.  Furthermore, seeking an alternate, commercially available medication, may result in a less effective treatment that may greatly affect your health.  We ask that you notify your local and state representatives, your employer and the NYS Department of Health to make them aware of this situation. 

    What You Can Do:

  •     1.       Customize this document and mail or email it to:

    a.       Your Insurance Plan (BlueCross BlueShield of WNY)

    b.      Your Employer or Entity from which you receive your insurance.

    c.       Your local news and media outlets (examples)

    2.       Contact the NYS Department of Health to voice your complaint:

    a.       https://www.health.ny.gov/health_care/consumer_information/complaint.htm

    b.      1-800-206-8125

  •     3.       Sign up for the mailing list to be informed of future developments.

  •  


     

    Express Scripts

    • What This Means to You:

    Express Scripts sent out this letter to your employer launching their new comprehensive compounding management strategy.  With this new strategy, Express Scripts will target 1000 ingredients in compounds and if a prescription comes through with any of these ingredients, the compound will not be covered.  This strategy will affect all patients in employer plans, for which Express Scripts is the pharmacy benefits manager.  Express Scripts is including EVERY employer plan in the program: therefore employers must opt out to be excluded from the program.

    Express Scripts plans to roll out its compounding management program in three phases:

    §  Phase 1 – Early adopters switch date is July 15, 2014 without patient pre-notification

    §  Phase 2 – Patients notification on July 15 with a 60-day pre-notification and switch on September 15, 2014

    §  Phase 3 – Union groups and large employers switch date is January 1, 2015

     

    Express Scripts is attempting to deprive you of a medication that your doctor, after careful examination, has determined to be the most effective and appropriate therapy for you.

    We are asking you, the patient, to keep in mind that a significant number of people have unique health needs that off-the-shelf, one-size-fits-all prescription medication cannot meet.  These include elderly, children, and those whom manufactured drug products are not available in the appropriate strength, dosage form, or composition.  For them and for you, customized medications are the only way to better health and those valuable preparations are available only by compounding.

    You MUST inform your employer to opt-out, please contact your employer plan account representative and include the following statement in writing;

    “Please do not enroll my members in Express Scripts’ Compound Management program at this time.”

    What You Can Do:

             1.       Customize this document and mail or email it to:

    a.       Your Employer

    b.      Your local news and media outlets

                                                                   i.      Buffalo News http://www.buffalonews.com/help/contact

    1.       Steven Watson (Business of Health Care) 716-849-3486, swatson@buffnews.com

             2.       Contact the NYS Department of Health to voice your complaint:

    a.       https://www.health.ny.gov/health_care/consumer_information/complaint.htm

    b.      1-800-206-8125  

  •      3.   Sign up for the mailing list to be informed of future developments


  • Notify your legislatures
  • Subscribe to PSSNY's mailing list to stay informed of the future developments by clicking here.  If you are having any issues, please Click Here for contact info.