Compounding Problems: Anthem Restricts Coverage Of Some Compounded Meds
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."
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