Is your medication at risk?
Express Scripts (ESI) has launched a new program that will exclude a majority of compounded prescriptions from coverage (with a few exceptions). The goal of this program is to save ESI’s clients money; however, it may have the unintended consequence of preventing access to the compounded medications many patients rely on.
Here’s the good news: This new program isn’t mandatory. If you are covered by ESI through your employee insurance, you can take steps to protect your access to compounded medication.
Here are 5 ways you can protect your compounds:
Find out if your prescription coverage is affected.
Insurance policies are notoriously complicated, so when in doubt, ask someone. You can read your benefits information or just talk to someone in your HR department. You should at the very least have a Summary of Benefits and Coverage you can refer to. Download the template below to see what it looks like.
Meet with your benefits manager.
The best way to protect your compounds is to voice your concerns face-to-face with the person responsible for making the decision to opt out. Download our guidelines to get the conversation started. We’ve also included a sample opt-out letter that you can email or print for your benefits manager.
After your conversation, make sure to follow up. We’re providing a sample follow-up email that you can customize and send to your benefits manager. Just click on the link below to open the PDF and copy and paste the text into the body of your email. Feel free to resend the sample opt-out letter as well.
If you can’t talk, write.
Everyone is busy, and it may not be feasible to get a face-to-face meeting. If that’s your situation, you can use the email and interoffice mail templates to make your voice heard. Just click on the link below to open the PDF and copy and paste the text into the body of your email. If you want to send a hard copy through interoffice mail, copy and paste into your word processing program, customize, print out and send. You can also save the sample opt-out letter and attach it to your email or print and send through interoffice mail.
Spread the word.
Tell your friends and co-workers about the situation and what they can do to protect coverage for compounded medication. We’ve provided some shareable social media graphics you can use on Facebook and Twitter to let people know about this issue. To use the social media graphics, click on the button below and use the sharing tools to share directly from ProtectMyCompounds.com, or save the images and share them from your computer.
Are you a PCCA member? Go here for tools to use in your pharmacy.