Does Medicare Cover Compounded Medications?

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Does Medicare Cover Compounded Medications?

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By Daniel Petkevich

Apr 4, 2023

Your plan should fit your prescription drug needs

Your prescription drugs don't have to be “One Size Fits All.” Compounded medications can offer flexibility and specialization when taking your prescriptions. But can they fit into your Medicare budget? Or do you have to pay for compounded medications out-of-pocket? Read on as we take a look at compounded medications on Medicare.

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Note: This content is for informational purposes only. You should consult with your doctor before taking any medication, including compounded medications.

What are Compounded Medications and why they may be needed

Compounded medications are what they sound like. They are drugs mixed and prepared specifically for you at a compound pharmacy. These special medications allow for greater customization in your healthcare, as these combinations can be tailor-made. According to

GoodRx

, some of the examples of medical professionals who might prescribe compounded medications include:

Dermatologists
Pain specialists
Podiatrists
Endocrinologists
Gastroenterologists
And more

While there are many useful applications for compounding medications, there are also some potential drawbacks.

Does Medicare Part D Cover Compounded Medications?

The answer to this question will depend on the specific medications you are using and the dosage. Generally,

Medicare

will not cover compounded medications. There might be some exceptions if the drugs that are compounded are both within their standard dosage and are listed on your Part D plan’s formulary. But as a rule of thumb, you should prepare for Medicare not to offer coverage for your compounded medications.

How to Find Out if Your Plan Covers Compounding?

The best way to determine if your Medicare Part D plan covers compounded medications is to review your plan's formulary, which is a list of covered medications. You can find this information on your plan's website or by calling your plan's customer service number.

When you review the formulary, look for a section that specifically lists compounded medications. If you do not see this section, you can also search for the specific ingredients in your compounded medication to see if they are covered under your plan.

It is also important to note that even if a compounded medication is covered under your plan, it may require prior authorization or have other restrictions, such as quantity limits or step therapy requirements. So, be sure to carefully review your plan's details and contact your plan if you have any questions or concerns.

Approaching Compounded Medications with Caution

If you are interested in or have already done additional research on compounded medications and Medicare, you might have seen an

HHS report

from 2014 about payment and oversight of compounded medications on

Part B of Medicare

. The report, likely introduced as a result of the fungal meningitis outbreak in 2012, acknowledged that certain compounded drugs can be covered by Part B, but that there have been issues with contamination. Following this report, the contamination and Medicare spending on compounded drugs have been under closer scrutiny. They might not be FDA-approved, and that means it can come with risks to your health in addition to your budget.

Tips for Saving Money on Compounded Medications

At Fair Square, we want to empower you to be your own best advocate. With that in mind, here are a few tips that

Medicare

beneficiaries can follow to save money on compounded medications:

Check with your
Medicare Part D plan
: Some Medicare Part D plans may offer coverage for compounded medications, so it is important to check with your plan to see if this is the case.
Consider alternative treatments: In some cases, there may be alternative treatments available that are covered by Medicare and do not require compounding. Talk to your healthcare provider to see if there are other options available for your condition.
Shop around for the best price: If you do need a compounded medication, shop around at different pharmacies to find the best price. Some pharmacies may charge more for compounded medications than others.
Ask for a cash price: In some cases, it may be less expensive to pay for a compounded medication out-of-pocket rather than using your insurance. Ask the pharmacy for a cash price and compare it to what you would pay with your insurance.
Consider using a compounding pharmacy: While Medicare does not cover compounded medications, some compounding pharmacies offer discounts or payment plans for patients who are paying out of pocket. Ask your healthcare provider or pharmacist for recommendations on compounding pharmacies in your area.

It is important to note that the safety and effectiveness of compounded medications may vary as they are not regulated by the FDA. It is important to discuss the risks and benefits of compounded medications with your healthcare provider before using them.

Questions to Ask About Coverage for Compounding Services

How do you know if your medication is compounded?

Ask your healthcare provider. They will be able to talk with you about the specifics of the medication you’re taking, and what your options are if you are interested in making a change.

What is a compounding pharmacy?

A compounding pharmacy is different from your average pharmacy. They can customize medications for you and for others who are looking for a more specific medication. You can do internet research on compounding pharmacies in your area, and speak with your Medicare plan provider to see if they are covered under your Part D plan.

What are some alternatives to compounded medications that are covered by Medicare?

There may be alternative treatments available that are covered by Medicare and do not require compounding. Talk to your healthcare provider to see if there are other options available for your condition. For example, there may be FDA-approved medications or medical devices that can be used instead of compounded medications.

How do I talk to my healthcare provider about compounded medications?

It's important to have an open and honest conversation with your healthcare provider about compounded medications. You can start by asking if there are any FDA-approved medications or treatments available for your condition. If your healthcare provider suggests a compounded medication, you can ask about the risks and benefits, as well as any potential alternatives. It's important to make sure you understand why the compounded medication is being recommended and how it will be prepared.

How do I know if a compounded medication is the right choice for my health condition?

The decision to use a compounded medication should be made in consultation with your healthcare provider. Your healthcare provider can help determine if a compounded medication is necessary and appropriate for your health condition. It's important to consider the risks and benefits of using a compounded medication, as well as any potential alternatives. Your healthcare provider can also help you understand the preparation and administration of the compounded medication, as well as any potential side effects or interactions with other medications you may be taking. Ultimately, the decision to use a compounded medication should be based on your individual healthcare needs and goals.

Conclusion

In conclusion, compounded medications can offer flexibility and specialization when taking your prescriptions. However, when it comes to Medicare coverage, the answer is not so straightforward. Generally, Medicare will not cover compounded medications, but there might be some exceptions if the drugs are listed on your Part D plan's formulary. It is important to approach compounded medications with caution as they may not be FDA-approved and can come with risks to your health and budget. Always consult with your doctor before taking any medication, including compounded medications, and follow these tips to save money on compounded medications while ensuring your safety and well-being. For all of your

Medicare questions

Fair Square

is here for you. Give us a call at 888-376-2028.

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Does Medicare Cover Compounded Medications?

Your plan should fit your prescription drug needs

Stay Up to Date on Medicare!

What are Compounded Medications and why they may be needed

Does Medicare Part D Cover Compounded Medications?

How to Find Out if Your Plan Covers Compounding?

Approaching Compounded Medications with Caution

Tips for Saving Money on Compounded Medications

Questions to Ask About Coverage for Compounding Services

Conclusion

Stay Up to Date on Medicare!

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