You can read below but this is additional paperwork or procedures for the doctor or his medical imageassistant to submit.  From what is being said here there’s a big opening to not approve drugs compounded that are not FDA approved.  What this could impact are old drugs that are still used but were around before the FDA existed.  There’s still quite a few of those out there.  Nice they let you know you can still get the drug but you have to pay full value if it not approved.  The wording there was just a little too authorative if you will.  BD 

We will implement prior authorization for all compounded drugs for HMO members in California, Washington and Oregon beginning July 1, 2014. 

The prior authorization will require that doctors providing services to these members tell us why member requires the compound product in order to determine if that member will continue to receive coverage. Compound medications containing bulk chemicals that have not been approved by the U.S. Food and Drug Administration (FDA) may not be covered. Prescription Drug Products covered under the pharmacy benefit plan must be approved by the FDA.

Please inform members that doctors need to pre-authorize compounded drugs by completing and submitting the online prior authorization request at >Healthcare Professionals> Prior Authorizations.

  1. The member’s doctor will need to give us information about why the compound is being prescribed.
  2. Once we review the information we will send members a letter to let them know if the medication is covered under their pharmacy benefit plan. 
    1. If coverage of the compound medication is approved, the member may fill the prescription using their pharmacy benefit.
    2. If coverage of the compound medication is not approved, the member can still get the compound medication, but they will have to pay the full cost of the prescription.


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