Medicare prescription plan formularies can be confusing, and different plans can cover different prescriptions. A common concern that comes up is whether compound drugs will be covered by Medicare. In this blog post, we will delve into what compound drugs are, why they might be necessary, and how Medicare coverage applies to them.
What are Compound Drugs?
Compound drugs are medications that are mixed by a pharmacist to meet the specific needs of a patient. This involves combining, mixing, or altering ingredients to create a tailored medication for a specific patient. A doctor may prescribe a compound medication for several reasons:
- Dosage Customization for patients that need doses that are not available.
- Allergy Avoidance for patients who need certain dyes or preservatives excluded from their dosage.
- Alternative forms if a patient has difficulty swallowing pills.
- Combination Medications with multiple medications into a single dose for easier management.
Compounded drugs are not FDA-approved. This means that FDA does not verify the safety or effectiveness of compounded drugs.
Does Medicare Cover Compound Drugs?
While Part D prescription drug formularies can vary from plan to plan, they typically do not cover compounded medications. Per the Centers for Medicare & Medicaid Services (CMS), “only those combination products approved and regulated in their combination form by the FDA as a drug…are eligible for Part D coverage”. As mentioned earlier, compound medications are not FDA approved.
However, some Extemporaneous Compounds may have partial drug coverage depending on the ingredients of the compound. Per CMS, “only compounds that contain at least one ingredient that independently meets the definition of a Part D drug, and that do not contain any ingredients covered under Part B as prescribed and dispensed or administered, may be covered under Part D. Only costs associated with those components that satisfy the definition of a Part D drug are allowable costs under Part D because the compounded products as a whole do not satisfy the definition of a Part D drug.”
Some Part D plan sponsors can still offer coverage for compounded medications, but you would want to speak with a licensed agent to see if there are any plans in your area that covers your specific compound.
How Can I Save on Compounded Medications?
Since compound drugs are not typically covered through Medicare, it is important to find ways to save when paying out of pocket. One option is to check with your doctor to see if alternative options are available that will be covered by your plan. If you cannot change your medication, then check different pharmacies to find the lowest price for people paying cash. Pharmacy prices can vary widely! You can also consider going directly to a compound pharmacy and find one that offers discounts.
If you need help searching Part D coverage, please reach out to our licensed agents today. We can search formularies of all major carriers to see which plans cover your medications at the lowest price.
