Saturday, August 31, 2013

Pharmalot Blog--Anthem Blue Cross Blue Shield ends coverage for compounded medications as of November 1

Compounding Problems: Anthem Restricts Coverage Of Some Compounded Meds

More fallout from the compounding controversy. Anthem Blue Cross Blue Shield, one of the nation's largest insurers, has decided to end reimbursement of certain compounded 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."

continue to read here


Anonymous said...

This should be considered white collar crime, theft by deception. We received a similar letter pertaining to bioidentical hormones. Their letter referred only to one ingredient in the compound, progesterone, 100 mg, used yo balance the main ingredient, C-triesto .25mg. Their letter failed to mention that the compound main ingredient. It took a year of many, many hours on the phone and manual submissions to get this straightened out as they tried to avoid payment on it last year, Now here we go again. We need legislation to reimburse people for their time in fighting these attempts to defraud us, and fines for these corporations.

Anonymous said...

Sorry for the spelling/wording errors, it would not let me edit it .

Anonymous said...

It seems from their letter that they are omitting the main ingredient for treatment, and instead just listing another ingredient in the compound as a method to deny coverage, Does everything have to be about money? Anthem, how about a little integrity?

Anonymous said...

I got one of Anthem's letters. I have testosterone compounded because there are no commercially available creams with the dosage I need -- as Rx'd by my endocrinologist. The letter says that they are ending coverage because testosterone is not approved by the FDA. The stupid thing is that testosterone is approved by the FDA so I don't even understand Anthem's letter. Anyway, I guess now I have to get 5 bottles of Androgel a month, which is going to cost Anthem $2,500 a month instead of the $20 Anthem pays after I chip n my $40 co-pay. Worse, Androgel does not even work -- no matter how much of the goop I smear on myself.