The practice of pharmacies mixing drugs especially for individual patients, known as “compounding”, was also blamed for the spike in “super spenders”. “A lot of creams and ointments were being mixed up with exotic things, and then the pharmacist was charging something like $10,000 versus pennies for some other product,” said Dr Glen Stettin, a senior vice-president at Express Scripts. Dr Stettin, who said some pharmacists had committed “egregious abuses”, added: “In the worst cases, pharmacists were crushing up nerve and pain pills and putting them into mixtures — who knows how safe they were.” Express Scripts said it has since reduced spending on compounded drugs by 95 per cent in its patient population, by putting in new controls to eliminate the practice.

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Drug ‘super spenders’ cost US healthcare system $52bn

David Crow in New York