Harvard Pilgrim Healthcare is trying to clarify its controversial policy to no longer cover compounded drugs in response to multiple pending lawsuits and conversations with state regulators, the insurance company said.
In a series of letters sent out yesterday to policyholders, employers and prescribers, Harvard Pilgrim is affirming that medically necessary compounded medications will be covered, a spokesperson said.
"Harvard's position has always been that it would cover medically necessary compounded drugs," Joan Fallon said. "We're making decisions based on medical necessity rather than excluding benefits."
"The revised letter comes out pretty plainly and clearly," said Bill Graham, Harvard Pilgrim's senior vice president for policy and government affairs. "We're not changing our policy."
Still, the change seems exactly what at least one of the lawsuits is asking for. "It appears that Harvard Pilgrim is changing course consistent with what we're seeking in the lawsuit," said Patrick Sheehan, one of the lawyers seeking a change on behalf of patients.
The original letter stated that "compounded drugs will no longer be covered under your prescription drug benefit." The last paragraph of the letter said doctors may request exemptions if there are no other available treatment options.
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