1+: Compound Drug Initiative Aimed at Lowering Costs

With health care costs on the rise, Anthem is always looking for ways to keep costs down while ensuring quality. Anthem takes the same care with compound drugs.

What’s a compound drug?
A compound drug is one prepared by a pharmacist for a specific patient. These drugs aren’t approved by the Food and Drug Administration (FDA) or reviewed by Anthem's Pharmacy and Therapeutics Committee.

What’s affecting the costs of compound drugs?
Over the past several years, the volume of compound drug claims has remained stable, while the cost per prescription has increased significantly.

What is Anthem doing to control costs and keep quality intact for employers?
In addition to compliance with new state and federal rules, Anthem will continue to apply plan design and clinical strategies to manage compounds.

They’ve taken active steps to ease the cost-of-care impact to employers, including:

1. Stopping payment, since November 2013, for select off-label bulk chemical prescriptions and ingredients not approved by the FDA, per existing benefit certificates
2. Communicating with members and providers about blocks, disruptions and discontinued drugs
3. Reviewing pharmacies, leading to the removal of some from the network

These actions saved more than $50 million for fully insured group business in 2014, plus more than $13 million for ASO (Administrative Services Only) employers.*          

What’s planned for the future?
Anthem will continue their efforts by:

• Involving their strategy work group, which is focused on pharmacy and medical management of compound drugs
• Monitoring trends, reviewing adjudication logic, options and best practice policies, as well as developing action plans for the best long-term solutions
• Sharing their ongoing efforts to drive costs down

For questions, please ​contact a member of your b&p Sales Team - 888.722.3373.

*Based on 2014 administrative services only (ASO) Commercial business.