Starting January 1, 2014, compound prescriptions equal to or greater than $200 per claim for members enrolled on Individual and Small Group metallic plans will require prior authorization. The pharmacy prior authorization list, including compounded medications that are more than $200, can be found here. These additions apply only to Individual and Small Group Metallic plans starting January 1, 2014.
Compound medications are “made from scratch” – individual ingredients are mixed together in the exact strength and dosage indicated by the prescribing doctor. This may be done for medically necessary reasons, such as to change the form of the medication from a solid pill to a liquid, to avoid a non-essential ingredient that the patient is allergic to, or to obtain the exact dose needed. The FDA has not approved any compounded drug products and it is not known if the compounds are safe and effective. Therefore compounded drugs may expose members to risks from products that have not been tested for safety or efficacy.
If you have any questions, please contact your sales team.