Jan Donley, a Jamaica Plain resident, will see her compounded medication for symptoms from menopause double in price this month because Harvard Pilgrim Heath Insurance is refusing to continue coverage of that type of drug.
Compounded medication is a combination of ingredients created specifically for a patient. Compounded medication was in the news last year when drugs from the New England Compounding Center led to a number of deaths, leading local state Rep. Jeffrey Sánchez to hold hearings and to industry reform.
Several lawsuits were filed last month by members of Harvard Pilgrim and compounding pharmacies seeking to prevent the non-coverage. Donley, who was put in touch with the Gazette through a pharmacy group, said she is not part of the lawsuits, but would like to see them successful.
Harvard Pilgrim would not respond to direct questions, but released a statement to the Gazette that said it is stopping coverage of compounded drugs due to cost and safety reasons. But the insurer will continue to cover compounded medication for people 18 years old and younger.
“We strongly feel that our policy is in the best interest of all of our members for quality, safety and cost reasons,” the statement said.
The statement went on to say, “Over the past several years, there has been a large increase in the use of compounded medications for uses that are not medically necessary like cosmetic, anti-aging and dieting uses, along with homeopathic compounds.”
Donley said she started suffering from insomnia and nausea due to menopause in 2011. She said “nothing the doctor did helped” until he prescribed a compounded hormonal cream that cost $50 with insurance.
“It’s been working really great,” she said.
Donley said a couple of months ago she received a letter from Harvard Pilgrim saying that in August, it would no longer cover compounded medication. That would mean her medication would double to $100. The letter stated that Harvard Pilgrim would consider an exception if her doctor deemed the medication necessary.
“I was upset. I’m not going to let it happen,” Donley said of her reaction.
She said she went through the process to get the exception letter from her doctor, but that it was denied by Harvard Pilgrim. Donley said she felt the health insurer did not read that letter carefully as the denial letter had the wrong name of the compounded medication in it.
Donley was able to appeal that decision, but heard back recently that that appeal was not approved. She said that the $50 a month she was paying with the insurance was already a financial burden and that $100 would be even more so.
“It is stressful. I’m really not in a place not to have the medication,” she said.
Donley said she does not understand Harvard Pilgrim’s decision to stop coverage for safety reasons, as the insurer will continue to cover the compounded medication for those 18 years old and younger.
“It doesn’t make any sense to me,” she said.