A Healthesystems publication

Fall 2014

Compounding Trends Are Cause for Concern

Emerging trends in compounding ingredients bring unwarranted costs and new potential for risk.

The safety concerns surrounding compound medications are well reported in the media — from a 2012 fungal meningitis outbreak caused by an injectable steroid made at a compounding pharmacy to the tragic death of an infant in 2014 due to exposure to a topical medication. Healthesystems has often reported the serious safety concerns associated with compounds including questionable quality control measures, adverse systemic events related to absorption, and lack of proven efficacy. 

Corticosteroid powder ingredient trends

Less examined are fluctuating ingredient trends found in compound medications that can have a profound impact on cost. A recent Healthesystems clinical analysis uncovered the increased use of certain corticosteroid powders that are quite expensive. Corticosteroid fluticasone powder has recently seen increased use in compound medications with an Average Wholesale Price (AWP) of $3,000 to $4,200 per gram, depending on the National Drug Code (NDC) submitted. A comparable ingredient with a significantly lower cost is triamcinolone with an AWP of $20 to $95 per gram, depending on the NDC submitted. Another comparable corticosteroid powder with a slightly higher cost than triamcinolone is Clobetasol powder with an AWP of $150 to $600 per gram. All of these corticosteroid powders are similar with the major differentiating factor being their cost.

comparable corticosteroid powders

Fluticasone

AWP

$3,000 - $4,200/g

Triamcinolone

AWP

$20-$95/g

Clobetasol

AWP

$150 - $600/g

NSAID ingredient trends

Our clinical analysis also revealed the recent emerging use of a non-steroidal anti-inflammatory (NSAID) ingredient, ketorolac. Toradol, the brand name medication containing this NSAID ingredient, has been billed using varying NDCs, with a vast discrepancy in price from an AWP of $150 per gram to $3,000 per gram. Compared to Voltaren 1% gel billed at an AWP of 50 cents per gram or diclofenac bulk powder with an AWP of approximately $15 per gram, a compound medication containing Toradol can cost upwards of 200 times more than equivalents.

The practice of inflating the costs of compound ingredients is not new to workers’ compensation, yet trends pertaining to the continued use of specific ingredients continue to evolve. In all instances, due to safety concerns, lack of proven efficacy, and inflated costs, compound medications should only be used when medically necessary.

Comparable NSAID Products

Toradol

AWP

$150-$3,000/g

Voltaren 1% gel

AWP

$.50/g

diclofenac bulk

AWP

~$15/g

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