Compound drugs, which require a prescription from a doctor, are prepared by a pharmacist who mixes or adjusts drug ingredients to customize a medication to meet a patient’s individual needs.
Differences Between Compound Drugs and Other Prescription Drugs
Compound drugs often have the same active ingredients as brand-name and generic prescription drugs but can differ from these medications in:
Coverage for Compound Drugs
Check your Evidence of Coverage (EOC) or member handbook to see if your plan covers compound drugs.
If compound drugs are covered by your plan, it’s important to remember that pharmacies that are in-network for regular prescription drugs may be out-of-network for compound drugs. Based on your pharmacy plan, you may not have to pay 100 percent of the drug’s cost if the pharmacy is in-network for compound drug prescriptions. Check your EOC or member handbook for more information on your plan's required copayment and/or deductible amounts.
You may have to pay more out of your pocket if you have a prescription for a compound drug filled at a pharmacy that is not in-network for compound drugs. Check your EOC or member handbook for more information on your plan's coverage for compound drugs purchased at a non-participating pharmacy.
If you have mail order benefits, you can obtain your compound drugs from the mail facility and have your mediations shipped directly to you.
Choosing a Compound Pharmacy
If you use compound drugs, make sure the pharmacy you use is in-network for filling compound drug prescriptions. You can do this three different ways:
How to Use the Online “Find a Pharmacy” Tool to Find a Compound Pharmacy:
Remember -- Pharmacies that are in-network for regular prescription drugs may be out-of-network for compound drugs. If you fill a prescription for a compound drug at a pharmacy that is not in-network for compound drugs, you may have to pay more out of your pocket for your medication.