Part D and Compounded Drugs?

[Northeast Agent]

Met a woman last night who will be aging in a few years. She told me she has severe allergies to sulfites, which are in most drugs and has her scripts mixed at a compounding pharmacy.

Does anyone know how this is covered by Part D?

 

[somarco]

AFAIK compounded drugs are not on any formulary, not covered by Part D

 

[TwoCents]

More than a few things come up on the Google, but I'm not digging through it.

 

[StephanieCJ]

What somarco said.

 

[WCMason]

What somarco said.

What Stephanie said Somarco said.

Also, if the drugs being compounded are drugs that would separately be covered by the Medicare Part D plan, then what some people do is get their medications through the plan, then take them to a compounding pharmacy where they can get them all mixed up for a compounding fee.

 

[Biggz33]

Here's a fairly oddly worded article on compounding.

When Can Medicare Beneficiaries Count on Coverage of Compounded Drugs?

 

[Hopes]

Regardless, of whether or not the compounding pharmacy or drug formulation is in network, can't the doctor ask for a formulary exception? If it's medically necessary...

 

[DS4]

can't the doctor ask for a formulary exception?

Yes, the dr can ask till cows fly.

 

[XpressInsurance]

The problem with compounding is for Medicare to approve a medication it must be FDA approved. The medications on their own have been proven effective for a condition but it has not been evaluated by the FDA for effectiveness as a compounded medication.

Many medications that are combo meds went thru the process of FDA approval.

 

[LostDollar]

Here's a fairly oddly worded article on compounding.

The article and the initial thread post present an interesting contrast.

The article complains about the food and drug administration not regulating compounded medications.

The thread post discusses CMS rules which require a beneficiary to use products which contain (for them-the beneficiary) poison.