Compounded medications are customized medication(s) made by mixing, assembling, packaging, or labeling drug (s) that are not commercially available in a specific dosage form, strength or formulation. These agents may serve as an alternative when nothing exactly alike is commercially available. However, they are not approved by the U.S. Food and Drug Administration (FDA) nor are they approved by our Pharmacy and Therapeutics process. Since there is limited oversight in the preparation of these compounded medications, there is a possibility that patients may be put at risk when prescribed a compounded medication that is not subject to quality testing that validates purity, stability or dosage.
Thus, due to the lack of data to adequately review these medications, compounded medications are considered non-preferred and are placed at the highest coverage tier (i.e., highest copay or coinsurance for non-formulary medications). They may also require prior authorization of benefits for coverage through a participating network pharmacy. And if a member chooses to receive the compounded medication from an out-of-network pharmacy, they may be responsible for a higher share of cost. As always, we rely on our physician providers to prescribe the most appropriate medication for our members to ensure their safety.