Compounding Problems: Anthem Restricts Coverage Of Some Compounded Meds


More fallout from the controversy. Blue Cross Blue Shield, one of the nation’s largest insurers, has decided to end reimbursement of certain medications as of November 1. Specifically, the insurer will not pay for compounded bulk powders or pharmaceutical adjuvants that are not approved by the FDA, according to a mailing that were sent to beneficiaries.

It is not clear if the policy applies across the board to both retail pharmacies and hospitals or whether Anthem has established a waiver policy for beneficiaries to appeal a reimbursement decision. We asked Anthem for comment and willl update you accordingly. A copy of the newsletter was obtained by Pharmalot.

The Anthem newsletter says that: “Due to the recent enhancement of the HIPAA (Health Insurance Portability and Accountability Act) standard for electronic submission of prescription drug claims, we now have the ability to better administer our drug benefits, as they pertain to compounded drugs. During a recent review, we learned that claims for certain compounded drugs have been submitted and paid as a prescription drug benefit.  For a compound drug to be covered it must contain at least one ingredient/drug that requires a prescription to obtain. Additionally, that ingredient/drug must also be approved by the Food and Drug Administration.”

The move is only the latest instance of a large insurer taking a tougher stance on compounded medications. In June, Harvard Pilgrim Health CareRead more

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