Harvard Pilgrim drops compound drug coverage


Harvard Pilgrim plans to stop covering specialty medications known as compounded drugs because it says the costs and safety concerns pose too great a risk.

The second largest health insurer in Massachusetts will end coverage of compounded drugs, which are specially mixed for patients who need formulations or doses not widely available, in August, reported The Boston Globe.

Harvard Pilgrim's decision, which only applies to adults, stems from a fungal meningitis outbreak in 2012 that caused 58 deaths and more than 700 sick individuals after a Massachusetts compounding pharmacy produced tainted steroids, the Associated Press reported.

"This is not about denying care," Michael Sherman, the chief medical officer at Harvard Pilgrim, told the Globe. "It's about eliminating costs that don't add value." In fact, Harvard Pilgrim found most claims it has received for compounded drugs were for medications that shouldn't be covered by an insurer anyway, including cosmetic, anti-aging, weight loss and homeopathic remedies, Sherman said.

Harvard Pilgrim did add that its new policy allows for appeals on a case-by-base basis. "If your physician believes that there are no other available treatment options for you, your physician may submit an exception request on your behalf," the insurer told its members in a letter announcing the decision.

But some pharmacists and patient advocates aren't pleased with the move. Todd Brown, executive director at the Massachusetts Independent Pharmacists Association, doesn't support the new policy or the company's reasoning for it.

"I don't think the safety concerns are really real," Brown told WBZ NewsRadio. "I think it's a thinly veiled attempt to justify their decrease in coverage."

To learn more:
- read the Boston Globe article
- see the Associated Press article
- check out the WBZ NewsRadio article

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