Compounding & Insurance

A Pharmacist Responsibility to Compound
Compounding is simply the mixing of two or more drugs to fill a doctor's prescription. Physicians prescribe compounded medications when they believe that it is the best therapy for the patient.
Compounding of medications by pharmacists is a longstanding and traditional part of pharmacy. The right - if not the obligation - to compound exists under the pharmacy laws of each of the fifty states and is pervasively regulated by the fifty states. States require that pharmacy schools must - as part of their core curriculum - instruct students on the compounding of pharmaceuticals.
Compounding, which benefits innumerable patients, has long played an integral part in the American health care system. Physicians routinely prescribe millions of compounded medications each year.

Compounded Medications and Reimbursment

Most insurance companies pay for compounded prescriptions with the exception of Medicare Part D prescription plans ( FDA approved bulk chemicals used in compounded prescriptions are not covered). Newly revised and updated electronic claims submission standards and software now allow for multiple ingredient compounds to be billed electronically.

As defined by the National Association of Boards of Pharmacy's Goods Compounding Practices Applicable to State-Licensed Pharmacies
The preparation, mixing, assembling, packaging, or labeling of a drug or device as the result of a practitioner's prescription drug order or initiative based on the practitioner/patient/pharmacist relationship in the course of professional practice or for the purpose of or as in incident to research, teaching or chemical analysis and not for sale or dispensing. Compounding also includes the preparation of drugs or devices in anticipation of prescription drug orders based on routine, regularly observed prescribing patterns.

International Academy of Compounding Pharmacists (IACP Code of Ethics

A compounding pharmacist is a state-licensed pharmacist who provides and promotes prescription compounding services utilizing his/her knowledge and skill in the art and skill of prescription compounding. Hereafter referred to as a "compounder". These principles of professional conduct are established to guide compounders in relationships with patients, fellow practitioners, other health care professionals and the public.
Compounders adhere to the American Pharmaceutical Associations's "Code of Ethics for Pharmacists."
Compounders comply with state laws regulating compounding pharmacy.
Compounders maintain the standards set by the National Association of Boards of Pharmacy, "Good compounding Practices for State-Licensed Pharmacies."
Compounders foster the triad relationship between the patient, the prescriber and the pharmacist.
Compounders seek to optimize treatment outcomes by providing clinical services to patients.
Compounders set personal continuing education goals to expand their prescription compounding knowledge base. Such resources as professional continuing education programs, online literature search services, peer networking and compounding-specific literature may be used to reach these goals.
Compounders adhere to professional standards when promoting their compounding services and utilize the triad relationship as a basis for such promotion.
Compounders should associate with organizations having for their objective the betterment of the profession of pharmacy and should contribute time and funds to carry on the work of these organizations.

IACP is an International Association of Compounding Pharmacists. If you have any questions about  this organization, please call 713-933-8400.
Last Updated: 8/22/2012