Medicare Part D Insurance and Compound Medications

Medicare part D prescription drug plans cover a lot of medications. Many of the medications that are covered on these insurance plans are medications that most people have never heard of. Although they aren’t all commonly used individually, these medications may be used in a compound medication.

There are times that Medicare beneficiaries are prescribed medications that have to be specially made. When a medication has to be specifically altered and made for a patient, that medication is known as a compound medication. Most people don’t realize that sometimes that is necessary to treat certain illnesses until they have to have it done. Those that have to pay for a compound medication understand why it’s important to have a big formulary.

Compound Medications and Insurance

A compound medication is a custom made medication and it can be expensive. Insurance companies look at compound medications the same way they look at other medications; they will pay for the portions of medications that are on their formulary. This is something that is odd to most Medicare part D beneficiaries.

Before a medication is placed on a Medicare part D insurance provider’s formulary, it has to come from a list of medications approved by the Centers for Medicare and Medicaid Services. If that medication isn’t approved by CMS (Centers for Medicare and Medicaid Services), it isn’t allowed to be covered on most part D formularies. Compound medications aren’t normally on the list of medications approved by CMS because they are made individually and sold individually. There may be components of a compound medication that is approved but the entire medication may not be approved.

When a Medicare part D beneficiary is prescribed a compound medication, it can be taken and filled at their local pharmacy as it normally is. The medication is filled and billed to the Medicare part D insurance provider as all medications are and the pricing is set then. The only part that a Medicare part D insurance provider will pay is for the medication that is on their approved formulary. Any other medications that are involved in the compound medication are subject to retail pricing.

Compound Medications and Pricing

The pricing of compound medications can vary. There are some compound medications that are extremely expensive and others that are very cheap. The price of those medications depends on the ingredients that are called for and the amount of medication made. When a Medicare part D beneficiary is told the amount of money they have to pay for that medication, they are often told the pricing of the medications in their compound prescription.

When a compound medication is filled at a pharmacy, that pharmacy can only charge the Medicare part D insurance for the medications that are on their formulary. The rest of the medications are subject to the prices of a secondary insurance (if available) or the prices that are set by the actual pharmacy. The prices that a pharmacy will charge for a medication can change. There is no contracted price for any medications that are not covered by an insurance provider.

Compound Medications and Paying

When it’s time for a compound medication to be paid for, some Medicare part D beneficiaries are hesitant to pay for it. There are some that are very expensive and hard to afford on most budgets. When a compound medication is prescribed, Medicare beneficiaries have a choice. They can pay for the compound medication out of pocket, file an appeal for their Medicare part D plan to help cover more of the cost, request alternative ingredients or refuse to pay for the medications and not take it as the doctor advised.

Those that choose to pay for their compound medication may only have to take the medications for a short amount of time. For Medicare beneficiaries, the out of pocket expense may be something they can afford at the time. Those that have to take the medication over a long period of time may want to request the compound medication to be paid by their Medicare part D insurance plan. Those that can’t afford the medications may ask for less expensive medications be used or they won’t pay for them at all.

All medications are prescribed for a reason. Those that have to take a compound medication can always call their Medicare part D insurance provider to get the details of their coverage for those medications. It is always advisable to have the pharmacist quote a price before having the medication filled. Since the cost of the medication and vary, it may be best to shop around first.

Dec. 30 13'
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May. 26 14'

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