Compounded Medications Can Help Our Wounded Soldiers — So Why Aren’t They Allowed?
It is commonly known that with each war, military medicine advances by leaps and bounds. Instead of overwhelming fatalities, we are bringing home soldiers with life-changing injuries. Soldiers often come back with hard-to-diagnose conditions, such as Gulf War Syndrome, which can encompass symptoms as disparate as memory loss and muscle spasms. They likely have post-traumatic stress disorder (PTSD) and other mental conditions, or may suffer from chronic musculoskeletal pain. They might have been exposed to unique toxins based on the combat theater they fought in, and they are probably at risk for infection by bacteria not commonly seen in civilian populations.
The one thing that is common between all of these soldiers, however, is that their conditions are complex and hard to treat with a one-size-fits-all regimen. Fortunately for these patients, compounding pharmacies have the right tools to provide the unique treatments they need. Unfortunately, under new rules from the military, pharmacists aren’t able to give wounded soldiers the best treatment they can receive.
Do you find this concerning? I do, and you should, too. Perhaps a health care provider’s worst nightmare is having the ability to treat a patient, but not being able to.
The TriCare Health Plan for Military Benefits
The program that determines what medical benefits military service members and their families are entitled to is called TriCare. According to the Department of Defense, 140,000 TRICARE beneficiaries filled 360,000 prescriptions for compounded medications in one year. However, in late 2014, the Department of Defense Pharmacy and Therapeutics Committee recommended restrictions on ingredients that compounding pharmacies often use, agreeing on a plan that would approve coverage for a compounded medicine if the patient had already tried available products, for the purpose and duration indicated.
Sounds like a good recommendation, right? Unfortunately, the Defense Department Beneficiary Advisory Board decided not to accept these recommendations. Citing cost and safety, they instead decided to make cuts in pharmaceutical coverage, with significantly reduced access to compounded medicines for our “nation’s best.”
Two advocacy organizations, Patients and Physicians for Rx Access and the International Academy of Compounding Pharmacists (IACP) “urged the Defense Health Agency to cover compounded medications without restriction.” Mr. Miller, of IACP, elaborated. “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.”
Miller’s position is the right one for patients — all individuals deserve to have access to medications prescribed to them by their doctors. Military service members are definitely owed that.
What Is TriCare Doing?
As of May 1, new procedures were put in place as to what prescription benefits TriCare patients can receive. In terms of compounded prescriptions, the process looks a bit like this:
- TriCare will screen individual ingredients in a compounded drug, like they do with ingredients in other prescriptions;
- If a compounded medication is affected by this screening, the patient will receive notice.
- At that point, the pharmacist can remove or substitute the unapproved ingredient with one that is approved.
- Or, the physician can prescribe another appropriate drug.
- Alternatively, the physician can request prior authorization for the unapproved drug.
The process seems cumbersome and frankly, has patients concerned. James McGee, a TRICARE beneficiary who uses a compounded topical cream, says, “I suffer from constant pain in my neck and lower back. 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.”
What Can Pharmacists Do?
Public response to the new changes has been lacking, even among pharmacists. Part of that may be because the new TriCare policy is intentionally vague. As pharmacists, we can perhaps use this uncertainty as an opportunity to educate policymakers, providing specific examples as to why the policy is not in the best interest of our soldiers.
Frankly, much of the media surrounding the new policy is about how the military is saving patients from the costs of medications that aren’t needed and aren’t effective anyway. Consider sharing this sentiment with your patients and see what they say. Make a note of their thoughts, then send that feedback along with an authorization request for a compounded medication. If enough requests for compounded treatments are submitted, policies may be more likely to evolve.
Our patients look to us for answers about the safety and efficacy of their treatments. We need to be able to look them back in the eye and tell them they are getting what they deserve: the best treatment for their condition.
Specialty compounded medications for military personnel is just one area in which we help you serve your community — and the people in it. We are committed to providing each and every customer with high-quality products and reliable information. For more about pharmaceutical compounding and purchasing bulk APIs, please contact Pharmaceutica North America, your trusted compounding resource.