In November 2015, a study published in Journal of the American Medical Association1 highlighted data that we have long known firsthand in the world of pharmaceutical compounding: the price of brand name and generic prescription medications have drastically risen over the past 6 years. The findings showed that between 2009 and 2015 alone, the retail prices of brand-name drugs for dermatologic care rose by 401% on average, generics by 279%. Drug prices are projected to go even higher.2,3
So what does this mean for dermatologists and the patient population in need? The unfortunate answer is in the data: more than 1 in 5 prescriptions will go unfilled.4 This is not good news for patients and it is not good news for their health care providers.
Compounding as an Alternative
As a compound pharmacy with over 30 years of experience in the business, it comes as a surprise that not more physicians are taking advantage of advanced compounding capabilities to better meet patient needs at a fraction of their out-of-pocket costs. The compounding industry is very well established and has been preparing prescriptions for decades that address a wide range of conditions from hyperpigmentation to hair loss, acne, eczema, and psoriasis.
Often dermatologists will first turn to compounding due to large-scale drug shortages in the marketplace. For example, this occurred when there was a nationwide shortage of tetracycline in 2013. The answer for acne patients and their physicians was for this treatment to be compounded on-demand.
Today, dermatologists are not just seeking out compounding as a short-term solution for shortages, but are looking for long-term, high quality, and efficacious prescription solutions that are able to provide optimal results at a price that a patient can absorb. It is a discernable shift in their prescription strategy.
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Cosmetic and Medical Needs
There are many examples of compound alternatives to commercial medications, however, some of the most common include:
1. Combining Multiple Medications for Rosacea
Given that rosacea is frequently considered an aesthetic vs a medical need, we see insurance companies rejecting claims to cover prescription medications, such as ivermectin cream, 1% (Soolantra). The resulting cost burden to the patient can reach up to $400 for a 30-day supply. In comparison, compounding enables us to combine niacinamide/azelaic acid/ivermectin (working synergistically for optimal effect) in a topical preparation at about $130 for a 30-day supply. Other options can include topical oxymetazoline as a stand-alone or in combination with ivermectin or, even more frequently, compounds with metronidazole and niacinamide created in a proprietary base formulated to replenish lamellar bilayers of the skin to help restore and nourish the skin barrier, reduce the appearance of redness, and preserve the integrity of the skin structure.
2. Solutions for Psoriasis
There is no question that etanercept (Enbrel) is an expensive solution that may not always work to address psoriasis and many insurance companies are unwilling to foot the $3500 bill for a monthly prescription. We often see that a topical medication is required to supplement the injectable biologic for patient care, which increases patient costs considerably. In both instances, compounded topical creams are options with the following formulas:
• Zinc pyrithione, clobetasol propionate, pentoxyfiline, cyanocobalamin, coal tar
• Tacrolimus, zinc pyrithione, cyanacobalamin
Both are strong solutions that may last longer than 30 days (depending on the surface area being treated) and come in at about $100 to $150.
3. Affordable Skin Bleaching Treatment
Melasma is still considered a primarily cosmetic concern even as it affects more than 5 million Americans, most of whom are women.5 The result is a hefty patient bill to treat the stubborn, hormonal pigmentation. The most common topical prescription medication on the market for the condition is Tri-Luma, which combines 4% hydroquinone, 0.05% tretinoin, and 0.01% fluocinolone acetenoide. It is sold for about $120 to $140 for 30 g. As an alternative, compounding allows for a formula that combines various strengths of hydroquinone, niacinamide, tretinoin, steroids, and non- hydroquinone bleaching agents upon the receipt of a valid prescription. This can average between $59 to $89 contingent upon patient needs and selected formula. (Price ranges are averaged based on one compounding pharmacy network’s pricing. Costs may vary and are subject to change.)
Samantha Blakeney is business development director at New Drug Loft Pharmacy and VLS Pharmacy in New York, NY.
Disclosure: The author reports no relevant financial relationships.
1. Kesselheim AS, Avorn J, Sarpatwari A. The high cost of prescription drugs in the United States. Origins and prospects for reform. JAMA. 2016;316(8):858-871.
2. Rosenberg ME, Rosenberg SP. Changes in retail prices of prescription dermatologic drugs from 2009 to 2015. JAMA Dermatol. 2016;152(2):158-163.
3. Armour S. U.S. prescription drug spending is on the rise. The Wall Street Journal. March 8, 2016. http://www.wsj.com/articles/u-s-prescription-drug-spending-is-on-the-rise-1457470800. Accessed November 22, 2016.
4. Fischer MA, Choudhry NK, Brill G, et al. Trouble getting started: predictors of primary medication nonadherence. Am J Med. 2011;124(11):1081.e9-1081.e22.
5. Sheth VM, Pandya AG. Melasma: a comprehensive update: part I. J Am Acad Dermatol. 2011;65(4):689-697.