Wiki Can pharmacy bill compounded medication?

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Some commercial carriers will cover the cost of compounded medications but they would be submitted through the member's PBM (pharmacy benefits manager) for consideration and may have prior authorization requirements. Additionally, many PBMs have specific compounding pharmacies that they contract with and as a result the member may not have benefits at a compounding pharmacy that is not part of their PBM's network of covered pharmacies.

I would make certain you obtain the patient's medical and prescription coverage information to verify benefits before proceeding with creating a compounded prescription for them so that your pharmacy is not left with a custom compounded prescription that the patient's insurance won't cover and they may not be able to afford to pay cash out of pocket for.
 
We prescribe some compounded medications, and I have not found a single pharmacy that will bill insurance for it. The patient can submit to try to get reimbursement, but I don't think anyone has done so.
 
CBLENNIE said:
Some commercial carriers will cover the cost of compounded medications but they would be submitted through the member's PBM (pharmacy benefits manager) for consideration and may have prior authorization requirements. Additionally, many PBMs have specific compounding pharmacies that they contract with and as a result the member may not have benefits at a compounding pharmacy that is not part of their PBM's network of covered pharmacies.

I would make certain you obtain the patient's medical and prescription coverage information to verify benefits before proceeding with creating a compounded prescription for them so that your pharmacy is not left with a custom compounded prescription that the patient's insurance won't cover and they may not be able to afford to pay cash out of pocket for.
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Thank you so much for your info(y)
 
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