We were interested to come across this press release issued by a law firm that has filed a suit against the pharmacy benefit manager Express Scripts on behalf of three pharmacies specializing in “compounds.” Compound medications are multi-ingredient custom prescriptions mixed for a specific patient. In the last two years the unit cost of these medications, often a cream or other topical treatment, has increased approximately 600%, with little or no additional therapeutic value being delivered for the additional cost. Some PBMs have addressed the escalation in cost by excluding specific compound ingredients. In response, many of the compounding pharmacies have substituted other ingredients to fill the prescriptions – and now three of them are suing the largest PBM for excluding some of their prescriptions. What should employers do? To begin with, look at your data. How much are you spending on compounds? What illnesses are they treating? Which pharmacies are the payments going to? Then talk to your PBM about how they are monitoring these scripts from a cost and quality perspective.