Express Scripts Sued in Scheme to Deny Pharmacy Payments for Compound Pharmaceuticals......

[BF7]

http://www.marketwatch.com/story/ex...imon-law-firm-2014-11-18?reflink=MW_news_stmp

"Three pharmacies have sued Express Scripts, Inc. for violations of federal regulations in a scheme to deny payments for compound pharmaceuticals. The suit alleges that thousands of patients are being impacted by the scheme, according to Quadrino Law Group and The Simon Law Firm.
The suit was brought in federal court in St. Louis on behalf of three compound pharmacies, two based in Texas and one in Louisiana. Express Scripts (ESI), based in St. Louis, is described as the largest U.S. claims administrator and fiduciary for health plan pharmacy claims.
According to the suit, Express Scripts has recently undertaken a scheme to reject all claims under health plans seeking payment for "compound" pharmaceuticals. These medicines are customized drugs made according to specific prescriptions written by doctors when there are no alternative medicines available that are either mass-produced or commercially made."

Less than 1% of Pharmacists actually fight for our profession's interests....good for these 3 pharmacies and their owners!

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[BF7]

And ESRX is laying off more employees.....

http://www.northjersey.com/news/business/express-scripts-lays-off-60-in-franklin-lakes-1.1126967


"In yet another round of layoffs, Express Scripts Holding Co. Wednesday let go 80 employees in New Jersey, including 60 at its facility in Franklin Lakes, the former headquarters of Medco Health Solutions Inc.
The St. Louis-based pharmacy-benefits manager also said it laid off another 320 workers across nation, Express Scripts spokesman Brian Henry said in an e-mail"

 

[Sparda29]

Whenever I see that I just bill them as separate ingredients. Only thing is we wouldn't get the $30-50 dispensing fee this way.

 

[BF7]

Whenever I see that I just bill them as separate ingredients. Only thing is we wouldn't get the $30-50 dispensing fee this way.

Generally speaking how are the dispense fees structured for compounds? and do you get paid over cost for simply billing the individual ingredients? So for a compound of 4 ingredients would you have 4 separate RX numbers? please advise..thanks

 

[Sparda29]

Well, I use Micromerchant so it's a pretty easy way of saving a compound. Enter all NDCs, lots, exp, how much of each NDC, compound ingred %.

I'll give you an example of our most popular compound.

Desonide .05% cream - 30 gm
Tretinoin .025% cream - 20 gm
Hydroquinone 4% cream - 10 gm

If all ingredients are covered, we generally get reimbursed well over $300 along with a $60 dispensing fee.

 

[BF7]

Well, I use Micromerchant so it's a pretty easy way of saving a compound. Enter all NDCs, lots, exp, how much of each NDC, compound ingred %.

I'll give you an example of our most popular compound.

Desonide .05% cream - 30 gm
Tretinoin .025% cream - 20 gm
Hydroquinone 4% cream - 10 gm

If all ingredients are covered, we generally get reimbursed well over $300 along with a $60 dispensing fee.

Thank you! Do you use micro merchant strictly for your compounds or for traditional dispensing as well?

 

[Sparda29]

Thank you! Do you use micro merchant strictly for your compounds or for traditional dispensing as well?

Everything.