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does medicare cover compound drugs

Does Medicare Cover Compounded Drugs?

We’re all familiar with over the counter or prescription drugs. While doses may vary, each drug is the same for everyone.

Compounded drugs, however, are different. These drugs are custom-made to meet a patient’s unique needs.

If you are considering compounded drugs, you may be wondering “Does Medicare cover Compounded Drugs?” In this article, we answer that question in clear, plain English. You will also find the average costs of compounded drugs, as well as other helpful info.

Does Medicare Cover Compounded Drugs?

The short answer is no. In most cases, Medicare will not cover the cost of a compounded drug. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your compounded drugs.

Original Medicare (Medicare Part A and Part B) does not provide coverage for compounded drugs. Medicare Part B generally does not provide coverage for compound drugs. They do not have an indicator to identify compound drugs.

Medicare Part D covers prescription drugs. And, most of the time, it does not provide coverage for compound drugs. There are some exceptions, however. If a compound drug contains at least one FDA-approved drug component, you may be able to get coverage. But that reimbursement is limited to the fees and costs associated with the FDA approved components.

Since neither Original Medicare nor Medicare Part D covers compound drugs, it is crucial to know how much they cost.

How Much Does Compound Drugs Cost?

Because they are custom, prices for compound drugs vary widely. They may start as low as $20 or so but can reach into the hundreds of dollars.

A number of factors affect the price of compound drugs. Two big ones are the costs of labor and the ingredients used to make the compound drugs. Other factors that may affect a compound drug’s price are the time it takes to create it and the cost of the tests for each drug.

What Is A Compound Drug?

Compounding is a method of creating a drug that is suited to the specific needs of the patient. Some people consider them as an option when commercial drugs did not work.

Licensed pharmacies often create compound drugs. Here are some ways a pharmacist can customize a drug to meet the needs of the patient:

  • Customize the dosage or strength of the drug
  • Add flavor to the drug to make it suitable for children or even pets
  • Reformulate the drug to remove some unwanted and nonessential ingredient/s that the patient may be allergic to
  • Change the form of the medication so that the patient may consume it with less trouble

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover ambulance services?

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