Friday, November 28, 2014

Overview of Texas Employees Group Benefits Program for Fiscal Year 2015: HealthSelect of Texas Benefits for Compounded Medication Coverage

Pharmacy Benefit Management Update
Compound Prescription Drugs
 Compound drugs products refers to a prescription medication product that requires
compounding by a pharmacist.
 Compound Drugs consist of two or more solid, semi-solid or liquid ingredients, at least one
of which is a Prescription Drug.
 Effective July 1, 2014, the coverage of compound drugs under the HealthSelect plan
administered by Caremark and the HealthSelect Medicare Rx plan administered by
SilverScript will entail a 2-step process.
 All Compound Medications with a cost greater than $300 will require a pre-authorization to
insure that it is being prescribed for a “medically accepted indication”; and
 Compounded prescription drug product may be covered if it contains at least one FDA
approved drug component, although reimbursement is limited to the compounding fees and
FDA approved component(s) only. Bulk chemicals are not FDA approved drug products.
Agenda item 5g - Meeting book dated May 20,2014

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