New guidelines have been issued by the Comptroller's Office which now require that, under our health plan, prior authorization be obtained for compound medications containing non-FDA approved ingredients. The issuance of the new guidelines was made by the Comptroller's Office without the consent of SEBAC. As a result SEBAC has filed a grievance contesting the state's right to unilaterally establish guidelines without SEBAC's consent. Follow the link to an FAQ issued by the Comptroller's Office regarding the new guidelines.
Compound drugs, which are largely unregulated, may contain non-FDA approved ingredients. Costs for compound drugs under the health plan was just $800,000 in FY 2012. That amount rose to approximately $24 million for FY 2015. In part, this is the result of some drug manufacturers aggressively marketing compound drugs, as cost controls over them are lax.
In some instances, compound drug manufactures have used expensive non-active filler ingredients to achieve astronomically large markups on their products.
SEBAC understands that the cost of compound drugs needs to be contained but wants to ensure those who need them get them at an appropriate cost level without excessive bureaucracy and lengthy appeals. Compound drugs have a proper place in our healthcare and need to remain available to those who need them. However, there is a difference of opinion as to how best to control the costs without disruption to the patients who utilize them. SEBAC will work with the Comptroller's Office to ensure that quality healthcare remains available to all state employees.
5/18/15