Battle Royale — Compounders vs. Big Pharma


The Rock 2013

I’m not exactly sure who to cheer for in this dispute between three compound pharmacies and Express Scripts.
In one corner we have the likes of Annie’s Apothecary and Mason’s Pharmacy, who are backed by some very creative and aggressive litigators. These plaintiffs are claiming ERISA fraud due to Express Scripts scheming to deny payments for critical compounding medicines as well as scaring patients regarding the safety and efficacy of their products.
As The Rock says, “Can you smell” the potential class action fees!?
In the other corner, we have Express Scripts, the very definition of Big Pharma weighing in at over $100 Billion in annual revenue.
This defendant has taken the position that most of the compounding pharmaceuticals they review for approval have greatly inflated prices and limited clinical benefits, and thus they intend to reduce spending in this area by 95%.
OMCA has been an innovator in the review and successful denial of inappropriate/ineffective pharmaceuticals for over twenty years. Compounding is merely the current flavor of the month. Pharmacy review in the workers’ comp arena requires the blocking and tackling fundamentals we practice each and every day. Work comp regulators require us to present the science on:

  • Safety;
  • Alternatives;
  • Relatedness;
  • Efficacy;
  • Pricing;
  • Outcomes.

You do this as your core mission, and eventually the rogue providers/dispensers look for an easier match.
Call us. We will be your tag team partner.

William Faris, JD
Chief Executive Officer

Posted in OMCA, Workers’ Compensation