Tuesday, July 23, 2013

Jul 23, 2013, 4:33pm EDT Compounding pharmacies sue Harvard Pilgrim


Reporter-Boston Business Journal


Three compounding pharmacies have filed a lawsuit in Norfolk Superior Court alleging that insurer Harvard Pilgrim Health Care is violating state law and contractual obligations by denyinghealth insurance coverage for compounded medicines.
Compounding pharmacies provide customized drugs for patients with a variety of different conditions, from eye diseases and cancer to infertility. Compounded medications are also formulated for individual patients who may be allergic to one or more components of a standard drug. Compounded drugs have been under intense scrutiny since last year’s meningitis outbreak that was linked to contaminated steroid injections compounded at the New England Compounding Center last fall. The NECC outbreak has caused 61 deaths and sickened 749 patients, according to the U.S. Centers for Disease Control.
The plaintiffs in the state suit, filed Friday in Norfolk Superior Court, are Bird’s Hill Pharmacy in Needham, Hopkinton Drug, and Johnson Compounding and Wellness Center in Waltham. Plaintiffs are seeking a preliminary injunction to prevent Harvard Pilgrim from denying medically necessary health care services through a prescription drug benefit policy change that is scheduled to take effect Aug. 7.
A separate but related civil complaint was filed in U.S. District Court in Boston Monday on behalf of a Jamaica Plain resident who is a Harvard Pilgrim member. This federal lawsuit also seeks an injunction as well as class-action status on behalf of other similarly situated patients.
“Harvard Pilgrim’s callous decision to cut off coverage is a major blow to the many patients across Massachusetts who depend on compounded medications, either because there is no commercially manufactured drug available or because they need a customized version,” Henry Abbott, owner of Bird’s Hill Pharmacy, said in a statement. “Many of our patients will no longer be able to afford these medications without insurance coverage, and we are worried about what this decision will mean for their health.”
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