Why are compounded medications not covered by insurance?
Compounded drugs are typically not covered by insurance. While compounding is necessary and still moderated by the FDA, especially for patient specific factors and times of drug shortage, the medications made do not have the same “approval” that manufactured FDA-approved drugs have.
The FDA is not able to verify the safety, effectiveness, or quality of compounded drugs before they are marketed or distributed to patients as they can with a typical drug manufacturing company. Some compounded drugs are also made with over-the-counter active ingredients which also are not typically covered by insurance.
If insurance companies do cover compounds, as they are not regulated in the same way as a manufactured product—the insurance companies typically determine the reimbursement the pharmacy receives. Because of this, in a lot of cases, compounding pharmacies tend to lose money as this reimbursement price can be less than the original cost of the ingredients they purchased—putting the pharmacy at a deficit.
How does this apply to Preston’s Pharmacy?
As mentioned above, insurance typically does not cover compounds, or if they do, it is not usually profitable for the pharmacy. Preston’s Pharmacy’s compounds fall within these same parameters. While Preston’s Pharmacy is willing to try to run insurance through (solely at the Arlington location), the most seamless way to receive your prescriptions with some of your healthcare benefits is through paying with a flexible spending account (FSA).
As another alternative, Preston’s Pharmacy also offers insurance claim forms that patients can submit to their insurance themselves.
If you have any further questions about compounding or insurance, our alternative claim options, or how this affects you and your prescription—please reach out!
We look forward to hearing from you and receiving your prescription today.
For more information please contact us at (571) 341-8787 or at wellness@prestonspharmacy.com
